Bella's Rehab - Introduction to Bella

So, I have a dog. I actually have 2 dogs, but this is about Bella. Here's a picture of the two- Kenzie, the shepherd lying on the really expensive bed I bought for Bella, who is ignoring it and lying on the floor, as she often does:

 

Bella is a 12 year old female spayed yellow Labrador Retriever. She was originally my parents' dog- my step-father got her as a Valentine's day gift for my mother. At the time, they lived in a place without a fenced in yard, so the dogs had to be leashed walked to go to the bathroom. Bella ended up with me after my step-father was involved in a car accident on Christmas eve. He was injured pretty badly. It actually ended up really screwing up his foot. He never walked normally after that, and really only had a few months of good walking and use out of it at all.  But anyway- my parents had 2 dogs at that time, and I was home for Christmas break. I offered to take one dog back to school with me, whichever was harder for my mom to handle alone. And I ended up taking Bella. She came back to Virginia Tech with me, she was with me for my internship at a warmblood breeding farm in northern Virginia, she was with me at NCSU for my last year of vet school. She did not come with me to Grenada, I did not think plane rides would be good for her- plus I lived in the dorms, no dogs allowed. A different regret I have is not taking the chance to live on a tropical beach when I had the opportunity, but I felt safer on campus, and didn't have to worry about anything but a food bill. 

Bella is a very sweet girl. She has been having progressive hind end weakness the last year, and some weird popping of her hind end (probably knees) I could never localize or re-create. She was actually a large part of the reason I wanted to learn acupuncture- to help keep her comfortable as she ages.  In July, she had a bad bout of diarrhea and vomiting, and was on fluids for 2-3 days, and got very weak. She has recovered mosty from that, but her hind end weakness took a significant jump forward. She now noticeable struggles to stand, and sometimes can't stand unaided if she falls over because she tried to walk backwards. I decided to seek out a rehab place to help keep her as strong as we can. I am able to life her when she goes down, but my mother can't, and she's the one who is usually he first one up with the dogs, feeding and taking them out. 

And I found PAWS  for Rehab about an hour away from me. Bella has had 3 sessions there, and I thought I would document her progress here. The plan is twice-weekly visits for 6 weeks. So far, I noticed an immediate improvement in energy after her first visit and laser therapy session, and am seriously considering a laser unit for home use. Laser therapy is used to aid healing and help with pain and inflammation in pets. It isn't suitable for all conditions- for instance, you don't want to use it over areas with tumors- but it is often used in arthritic patients as an additional modality for pain relief. I'm running out of reasonable drug options to try- I have a few left I can switch to if needed, but not a lot so any non-medication pain relief options are of interest to me. I am also looking into Asissi loops but that will be in the future, after her rehab. 

Her first session was underwater treadmill and laser, the second visit they showed me exercises to do at home, and today was massage (and maybe something else-  I pre-paid for all 6 weeks, so I forget).

Bella is really eager on the car rides there. I think she also misses riding shotgun, since she used to for our car trips until I got this car. the leather seats are too slick for her, and the floor is further down from the seat, harder for her to put her front legs on the floor and sit in the chair like she used to.

She tends to sleep a little more on the ride back- the excitement of getting there and seeing people wears her out.

I forgot to take pictures the first time there, so these are the car ride from our second trip. She wears the Help 'em up harness for car rides so i can catch her and lift her into and out of the car easier-. She still tries to jump in and out, though it doesn't end well for her without help.

I did get a picture of her being really pushy and demanding a walk after her first visit

Our current homework is 4 exercises to strengthen her back end and core muscles. I am trying to figure out the best way to work doing these 2-3 times a day into our schedule without just taking a huge chunk of time to do it all at once, which doesn't really give the best benefit. They're fairly simple exercises to do, it's just remembering to do them throughout the day. Tomorrow is my first full day back at work since I was given the exercises, so I am planning to split things up into 4 or 5 chunks of time- first thing in the morning, ideally with a walk if I can wake myself up that early, when I get home for lunch and before I leave from lunch to go back to work, when I get home from work, and before bed. That is my tentative plan at the moment, I will update as we go along with progress and pictures. I can say, one of our exercises is standing on the stairs with her front paws for several seconds. She's already showing some improvement there- mostly that she realizes I am not trying to make her go up the stairs, which she has not done since early July. She's extremely food motivated, which helps a lot. 

How Do I know?

I'm trying to give these things more structure, less stream of consciousness/verbal diarrhea.

So this week's post- one of the tough ones. Rarely do people come out and say Doc, how do I know when it's time? But in a myriad of little ways- I don't want my pet to suffer doc. I don't want to pursue needless testing. I don't want to put them through painful treatments. I don't want to wait too long. I don't want to give up too soon.

I am an eternal optimist- and it's a flaw. I try to be realistic, but one of the truths of the world is there are very few absolutes. So when people ask me- is there any chance? I say yeah, a slim one. But I've heard the cases, the one-in-a-million's that live past the expectations. Of course, I've also heard the apparently benign turned out to be terrible and died young, but they don't stick out as often as the other. So sometimes I feel like I give people more hope than their situation warrants.

This has been something I've been pondering a lot lately, because the last week the thought of my own dog's euthanasia has been heavy on my mind. Lina, the last dog I had to euthanize, still weighs heavy on my mind. I didn't know as much, I didn't know what else I could do- and I feel I failed her.

Bella, who has been with me since undergrad. VA Tech and NC state (I did not subject her to Grenada- the plane rides would not have been fun for her), my first job, my current job, all 3 boyfriends- is getting old. And it is showing. She has an arrhythmia and arthritis. She has some pretty bad muscle wasting in her hind limbs, and is starting to have trouble getting around. She is currently on 2 arthritis medications, 1 heart medications, a joint supplement and prescription joint food. And I do acupuncture on her, perhaps not often enough. I've tried other medications, and I am considering swapping hers up a bit more, but I also realize that no amount of medication is going to make her run up the stairs again.

There are a variety of resources out there to help people decide. Lap of Love,  an in-home hospice and euthanasia service, had an app, Grey Muzzle. The Ohio State University has it's own thing. And I'm sure there are others.

A lot of my information I provide to clients I repeat so often it sounds like a rehearsed speech. Vaccine reactions, heartworm prevention, my pre-euthanasia "this is what is will look like" talk. I don'r have one for this. How do I know when it's time? It's different for every pet and owner, and truth is sometimes euthanasia is a viable option that I discuss with clients, for treatable conditions. And those are the toughest- because yes is is the right decision for this pet and this client, but that doesn't mean it isn't hard or I don't wonder "if only we did this" or had tried that.

But back to the question- how do I know when it's time? Some pets make it really easy, and come down with something that will kill them. It sounds harsh, but that's how I recently phrased something to a client: you will have to decide when it is time for your pet because what she has now will not kill her but it will make her really painful and affect her quality of life. The ones where it's deadly and I can give you an estimated life expectancy are in some ways easier- then you have a goal. This will kill my pet, so when I start to see bad days, it's time.

The others are harder- the this won't kill my pet but it will make them miserable, and painful, and require a lot of supportive care to keep them in a reasonably comfortable state. And that's where Bella is at.

So where is my line for her going to be? I still have 2 or 3 medications I can try. I can increase acupuncture frequency. I can send her to physical therapy. I still have some options.

But when those run out? She's a lab, she'd wag her tail and eat something for me until the end. Is my line going to be she can't walk on the slick floors? She can't stand up unassisted? She can't make it the 2 inch step outside to go to the bathroom?  Or is it going to be subtler- she's panting and grimacing in pain occasionally now. If I can't get that expression off her face, is that my sign?

It's the hardest choice you can make as a pet owner, and sometimes the kindest thing you can do for your pet. And it's rarely easy, and always heartbreaking. And my job as a vet is to guide people to these decisions, but I can never pull the trigger. I get asked all the time, what would you do doc? If this was your pet? And I answer as honestly as I can, but I do tell people I'm in a different situation. That's sometimes the hardest question to answer- what would you do if this was your pet?

And writing this, I hope I know it when I see it. Another vet, somewhere on the internet, once said she's heard a lot of clients say they waited too long, and not as many say they gave up too soon. Once I do make the decision for Bella, I'll have to decide- am I going to be the vet for my dog's euthanasia, or the client?

Tough Days

This back end of this week was full of tough days.

Thursday was a tough day- for multiple reasons. I woke up, before my alarm, to a text from one of my techs asking if it was OK to bring her dog in for some bloodwork +/- euthanasia. That turned into just euthanasia. It was absolutely warranted. And she thanked me afterwards,, and her wife brought us all smoothies afterwards. And being thanked for euthanasia is hard.  I don't feel like I did a service there. She made the decisions herself, I just agreed it was warranted. She placed the catheter. I just pushed drugs and left her alone.

And there was another euthanasia that afternoon that felt pretty similar. Older golden, long time client, close to most of the staff. I don't usually cry during euthanasias, but I was getting teary during that one.

They also thanked us for the euthanasia. And it's always hard for me to hear. I try, I try to make euthanasias as smooth and painless a process as anyone could want. But people thanking me for it is still hard to hear. I never know how to respond.

And the schedule wasn't overly packed, but decently full, and we were down a person. My tech had been scheduled to work and of course we weren't going to have her work after that morning. No way. Work the day you euthanasize your pet? No. I can't imagine.

Then Friday, that was a hard day physically. The schedule looked easy- cat dentals go really quick if the teeth are healthy, and 2 of my 4 scheduled were cats. These teeth weren't healthy. I tell people when they ask if I really have to remove the teeth I recommend that they say "it's like pulling teeth" fora  reason because that is NOT fun. 3 of my 4 dentals (both the cats) needed 3 teeth removed, each of them a canine tooth too. It's great when you flip through the book for a reminder on how to do the gingival flap and the first sentence calls it the most difficult tooth in veterinary dentistry to extract. Feline lower canine teeth. I have referred in the past, for fear I might break a jaw when removing one, but I felt confident that day. I definitely undercharged for my time and the procedure, but I wanted the pets to get these teeth out, they were painful. I've been working on picking up dental skills. We did not get a lot of training in school. Not nearly enough to be proficient- but really that's the way school is. They teach you enough so you can learn the rest on your own.

Well, sort of. That's not the best description- they teach you what you need to know, but there is so much you need to know. So a lot of things they touch on enough to get you started, and give you places to look for the weird, specific stuff that comes up. Because you can't see everything in school or you'd never be able to finish. That's one of my favorite things about my career- there is always more to learn and grow and do. And one of the scariest things coming straight out of school- there is so much more to learn. 4 years out and I still feel like a new grad some days.

Saturday was good though. A holiday, the emergency that came in actually resolved well, left apparently healthy. The sick pet I fit in had a possible cause of her problems and we started treatment. I hate the, what one of my teachers called "nebulopathies" the something's wrong but we don't know what so we're making educated guesses on what to do while we continue to work things up. Here's hoping she gets better on the medication.

And that brings us to Sunday, where I work at my vaccine clinic job. Which was when I started writing this post, about to comment on how it's an easy job. And then I jinxed myself. It was as bad as it I'd said the Q-word. I stayed an hour and a half late, and saw double the pets I normally do. Luckily at least a third were adorable puppies, but it was exhausting.

And then Monday and Tuesday decided to get in on the action in small ways thankfully- our internet was down on Monday morning so no one could clock in, and on Tuesday our pet care software was down- no histories, no ability to take payments or check anyone on or see the schedule. Luckily it came back on after an hour, but my first client was a brand new pet we would have to take payment from- well, we would have. If I had been able to examine the dog- he was too aggressive for me to get near, lunging/barking. I did a free exam coupon and sent them with a script for oral sedation to get at a human pharmacy and some guidelines on muzzle training at home. Here's hoping it goes better in 2 weeks. Who decided I was the angry dog whisperer at work? It can get rather stressful somedays. Plus we were down a person. 

In WoW, I've come to the realization that I'm not as good as I think I am. It comes up every few months when I try to do something, struggle, and fail. It hit me hard this week since it started on Thursday and continued through Friday. I've been making changes to my UI, trying new things with healing mythic plus, trying to do the damage I see other healers do. And I'm failing. And it just made me pretty down on myself this past weekend. I'm back on the upswing of not caring and still having fun now, so yay there.

I'm also struggling with what to say to someone who has a profile picture in discord that is not appropriate for our discord. But this guy popped in once for 10 minutes then left. He has an alt in the guild, just 1, and barely plays in the guild. So how do I approach that? Still trying to figure it out.

But I was the one who felt it was inappropriate, who felt I needed to talk to the guy. I just feel, with all the stuff that comes out, if I allow things I think are demeaning to women to stand without a comment now I am contributing to the issue. Right now I'm waiting to see if he's going to be more active in our discord before really saying anything. And I still don't know what to say. It's a work in progress.

And now, 6 days off in a row! Without having to go to any continuing education- though I will be catching up on some online. I'm excited for the break, even if a trip to New Jersey is not my ideal vacation, but family is family. See ya later!

Convenience Euthanasia

This week has been full of sensitive topics. In the game world, there are sexual assault victims coming forward about a well known player. It is a difficult topic to discuss, and everyone coming forward to share their experiences is incredibly brave. And I hope it prevents people from being hurt in the future, and I am heartsick that people had to go through those experiences in the first place.

I am lucky. I have never experienced a similar situation. My heart goes out to the brave people coming forward to prevent future cases.

In the vet world, I came across the following article. I can't appear to get a link working- so here it is: https://www.facebook.com/haoting.chow/posts/10158955082305572


I'm not sure how well that links, but below is a piece from a veterinarian on a sensitive topic- aggressive pet euthanasia and convenience euthanasia. I have never performed what I consider a convenience euthanasia, but I have euthanized animals for treatable conditions. In some cases,  even with  treatment they had a poor prognosis. In some cases, the condition was treatable but the treatment would be tough, or was expensive. It's a fact of being a veterinarian that you will euthanize something for a treatable condition due to finances. In my cases, that particular experience was a GDV, which can have a poor prognosis and a number of GVDs end up euthanized on the table when you see the extent of the damage to the stomach and intestines.

I have been asked to perform what I considered a convenience euthanasia as a vet once, and as an assistant to schedule one by a client once. That case was someone moving who did not think her adult cats would adjust to living with anyone else and did not want to surrender them. We did not schedule her. The case where I was the veterinarian was scheduled as dog with malformed legs, owner requests euthanasia. It sticks in my mind rather vividly, since it was my first time encountering this as a vet.

It was a mastiff, with normal conformation, who had really bad flea allergies. The owner was also complaining the dog wouldn't eat anything, but when we put canned food in front of him he gobbled it up. And she said "well of course he'll eat canned food" but she refused to try changing his food at home. She claimed he had lost 20 pounds due to lack of appetite- records we had showed a 3 lb weight difference. I refused to euthanize, and that was the first time I really felt supported at that job as my boss told me she would stand behind that decision. The owner refused to surrender (I worked at a shelter at the time and we would have taken him and treated), and agreed to try treatment. Came back 2 or 3 days later screaming about how I don't have to live with the dog peeing everywhere because of the steroid we put it on, and how they can't just let him stay outside because their neighbor will feed him even though one of their complaints was the dog wouldn't eat. She eventually left after we refused to euthanize a healthy dog with a treatable condition that we were willing to take on.

That is my line for euthanizing treatable conditions- am I willing to take this case on if the owner will surrender it and find it a home or keep it myself? If I can't conceivably treat the case, how can I expect the owner to?  I suppose the best example of this is diabetic pets: I discuss (more with dogs than cats, due to the nature of the condition in the different species) with all new diabetic pet owners euthanasia when the diagnosis is made. If you can't treat this, I tell people, consider euthanasia. Dying of diabetic ketoacidosis is not a kind way to go. I would rather euthanize before they get to that point than have an owner willfully not treat.

My other line for euthanizing is aggression. I have an aggressive German Shepherd myself. She is great with me, and will let me do anything to her, but she will try to bite strangers. I give her medication before company comes to my house. I put her up if I can, avoid the issue altogether. I muzzle her if she has to come to work with me. And in the past, my family worried that we would have to euthanize her.

I have never felt unsafe around my dog. She has never shown aggression towards me or my family. But if did, I would euthanize. I am not sure I could do it- I have not been a vet long enough to have to euthanize my own pets, but as they get older I know that day is coming and I still don't know what I will do.

But on the issue of aggression- I love animals, but human lives are just as valuable. If a dog is showing aggression towards people, and I refuse to euthanize, and it goes on to maim a child- I feel like that would be on me. That is the one case I will euthanize even a sweet, seemingly healthy animal. I will certainly ask some questions- what was the situation, do an exam to see if the pet is painful and the child hurt it. But I have euthanized a young, physically healthy dog while the owner sat there with bandages on her arms crying because she was unpredictably aggressive. I have euthanized a physically healthy pit bull in the shelter who just would not allow anyone to safely handle her even with slow, careful attempts and much time spent trying.

And I believe that while these dogs may be physically healthy, they are not mentally healthy well adjusted dogs. And these are some of the hardest euthanasias to do, and some of the hardest decisions their owners can make. It's easy to euthanize a physically sick dog, when you can see how bad of fit is.. It is so much harder to make that decision for a mentally sick dog who is physically healthy. But living in fear of your pet, and for a pet to live in potentially isolation if that's the only safe way to handle it, is no kind of life. I have worried about having to euthanize my own dog for this reason, and cried over it multiple times. I have not had to thank God, but I can understand where the decision comes from. And it is the one case where I will euthanize physically healthy patients.

Euthanasia is the toughest decision you cam make for your pet. There are all kinds of quality of life scales designed to help people come to that decision. And all kinds of clients who want me to tell them it is time. And that is something I cannot do. I will honestly tell people if I think their pet is suffering. But I also tell people we can throw money at diagnostics and potential treatments for a long time before getting there. And is a temporary suffering that the pet may recover from like an episode of CHF that is improving a reason to euthanize? Getting past that episode may be more than some people can afford to spend though, and that is understandable. Or a broken limb- that's certainly suffering, but a healable injury for sure. Anyone who comes to be after making the serious decision to euthanize I will evaluate. It is not an easy decision to come to.

But as I told the woman with the mastiff- I have to be able to live with my decision to euthanize. And as she yelled back at me, I don't have to live with the pet I refuse to euthanize. (though she didn't have to either- we offered to take him) But that is the question I ask for every treatable condition- can I live with this pet, if the owner can't? Thank goodness a lot of them have no idea we can treat their pet's issues and are willing to try when they find out we can.

But I cannot kill a perfectly healthy pet because the owner just doesn't want it anymore. A lot of  my cases stay with me. I sometimes forget their names- I very often forget the owners. But I can see the brown shih tzu developing heart failure and the older woman who can barely afford the exam fee to see me, much less the ~$100 /mo of medication alone her dog would need, not even talking about the blood work monitoring.  And the 13 year old dog with GDV who has been having issues for days. And the older lab with a hemoabdomen, We waited for their adult children who grew up her to get there before she was euthanized. All potentially treatable, but unlikely to have a good prognosis. 

I could go on and on. I don't remember every pet I euthanized- I don't even remember the number. Some stick with me more than others. My goal is always euthansaia- a good death. A peaceful passing for the pet and owner, the best final gift I can give my patients. And I dread the time for so many of my patients, and  thinking about this is making me treat up. Though I have been especially emotionally  unsteady lately- lack of sleep + bad diet = teary and / or easily angered Nala.

At one point I seriously considered a job in palliative care and home euthanasia. I am not sure I am cut out for such a position at this time in my life. But I still put a lot of effort into my euthanasias.

As I re-read what I wrote, I keep thinking of more and more cases- some heartrendingly sad, some sweet. This has dragged on way longer than I meant it to, but I wonder if I should write the stories down somewhere.

Work Changes

A little bit of change at work this week, the new doctor started. I call her new, she just transferred from out of state. She's not a baby doctor or anything. Seems nice enough. Still getting used to the other new doctor who transferred a few weeks ago. We went from 2 full time 1 part time doctors, to 1 full time (me) and 4 part time. Part time at our location, they're all splitting time with other hospitals. It's a change, trying to get used to it. It doesn't help that we're still opening an hour later so I don't get time to get there a few minutes early, look at the schedule, get a game plan.  I'm hopeful we'll be back to our normal opening time soon, but there's no end in sight yet.

My current work/life struggle is being managed. We've been pretty busy- I've heard a lot of vet clinics have been slammed, and there have been some ERs turning people away. It's been crazy. Some of it has been normal things that people just never noticed and didn't realize were normal- like the male dog nipple ticks, saliva staining on paws not blood (though not normal, not an emergency) and smegma. It just makes it worrisome that the real emergencies won't get treatment in a timely manner. Though you can't help people who won't seek treatment because they don't want to pay the ER fee.

In WoW news, we killed Drest, yay! Not a fun fight to heal, everyone is so spread out. And my innervate-giver swapped from druid to hunter so I have to play a little more conservatively with my mana.

We had a bit of raid drama. Some people have been swapblasting other people to their deaths. I've been a victim of my boyfriend doing it since Blackrock Foundry, and it annoys the shit out of me, so I get it. Other people started, someone got pissed off and left. In return, someone got upset at him for leaving and swapped the crap out of him the next night. And I just want people to be adults and move on. We should not need to have a discussion about not being a dick to people in raid. We are all adults. But I suppose it fits in with my work-mandate professional development plan- this year I am working on communication skills. 

I failed at communication there. I knew there was a problem and took no action to stop it. I made a few passive comments about it, but didn't really do anything. I probably should have. Maybe I should read that fierce conversations book that was recommended to me.

I've been in another negative downward spiral- little things are really getting to me. I'm not really trying the healthier thing so much right now. Stress hits and I go open a bag of potato chips or ice cream. That's probably contributing. And being so busy at work I have to constantly be moving, planning, doing something in the most efficient manner possible to keep on track has been wearing me down. I like being busy- I hate being overwhelmed. It has made me snappy and overly sensitive to things I would normally shrug off. 

Here's to trying to be better next week!

Brain Problems

I had a really good day on a number of levels, but I still let the bad thoughts win today. And I wonder why my brain is primed that way.

I saw 2 of my favorite patients today. A sweet dog and a really nice cat. And instead, I focus on the 5 bad dogs I saw. I did really well today, kept on schedule even though we were busy- I had an awesome team today, 2 of my favorite co-workers. One of them, at one point, I thought should be fired for a toxic attitude and some poor work performance. But that's another story. We get along well now, and I think we work well together now that we have figured each other out. Makes me think of that Anne Bishop quote, some people need a hard lesson and some people are the hard lesson. I have had to learn a lot about how to get along with co-workers, and how easy going I am apparently not. I always thought I was...

But, back to my main thought: Nothing objectively bad really happened today. Sure, we had some difficult to work with dogs, and one kind of scary dog, but things went well. Raid, where some things did go poorly, was well after this point in my day. Why was I so down on what should have been a good day?

I'm working on being healthier- trying to feel my feelings in stead of eating them (which is what this post is about), sometimes trying for  more sleep. That one is tough, so many of the people I do things with are more nocturnal than I am. And I end up staying up way later doing things I don't need to do. So many of the things I am reading and listening to now talk about the mental side of things. Shaping your thoughts to get the feelings you desire, or stepping back to the facts and figuring out what you are feeling and thinking about them.  Mindful meditation, taking care of yourself.

I feel like some days I am too busy to have time for this stuff. Then I wonder if I'm a workaholic- I just went down a day on my schedule and immediately wondered if  I should pick up ER relief shifts for extra cash. I constantly worry about debt repayment- student loans are killer. I went down a day for my health, and mental well being so at this time I have not started looking for another part time job.

But veterinarians have a higher suicide risk than you might expect. And I am aware of that, and sometimes it pops into my daily life. A colleague walked out of the building with her drug box and committed suicide in a car. Not one I know personally, but works for the same company. We have to, as part of our AHAA accreditation, have information about suicide prevention on our controlled drug boxes. And when I hear stories like that, I want to be a healthier person- physically and mentally.

I would like to be able to feel like myself again. I hadn't realized I had stopped feeling that way until I suddenly felt normal a few weeks ago. I've been talking a lot with a friend about depression, and how it can affect your personality. I've often wondered if I need outside help. But then I feel like I have not time, and continue to tackle it all myself. Until I give up and go eat my feelings again.

I don't know why my brain focuses more on the negatives than positives. Always on the mistakes, not the good.  I think I'll start with a small effort- I have a hard time telling other people they are doing well when they are doing the minimum I expect them to do- their job. Looking for good things, complimenting people, might give me  a reason to look for the good outcomes, see the bright side, instead of focusing on the bad things that I may not be able to affect. Or help me recognize the things I can actually fix.

If you've read through this long- here's a picture of my dogs:


And here's a tidbit of vet knowledge: there is no best dog food. Some foods are better than others, but in general if your pet is eating it well, normal stool, nice coat and no itchiness or other skin issues the food is probably ok. Though I do recommend making sure it is AAFCO certified, ideally food trial tested- it will say somewhere on the bag. I get that question a lot from people.

So much new stuff!

So much change in my life right now, mostly with work.

I am super excited that, starting in June, I am going to be going from 4 days one week/5 days next week to a 4/4 schedule at work. An extra 2 days off a month! I immediately took a look at ERs in my area, and thought about picking up shifts. I think I might be a bit of a workaholic. I did stop myself since I am going down a day because I feel exhausted and over worked.

I am also getting a new boss and a new co-worker. My solo doctor days may be over. Not sure how I feel about that. The new doctor likes to bake, I've heard, which is a big plus. But new people can be scary. Especially when one of them is going to be my boss. I'm a little nervous about that. It'll only be for a year, then she will likely be moving.

In the WoW world, we killed Hivemind, yay! We're 5/12 mythic now. I am learning disc, slowly, and not very well. I'll probably be holy the rest of the expansion really, but I will keep working at it. We have some new people in the guild, I will have to make an effort to reach out. So many names I don't know now.

Our current raid discussion is what to do with behavior we do not want to allow. Can we afford to ask someone to sit when they did something that needs to be acknowledged as a bad decision? We'll see what happens there. TBC I suppose.

Good night!

Shad'har Fun! And some doctory thoughts....

So we're wiping to Shad'har- 2% wipe! We totally have it tonight. I should probably give our under-geared pally a vantus rune.....


But while I lie dead on the floor there, I thought I'd write about something that has been ruminating in my head since Friday: I had a St Bernard spay on Friday. >100 lbs, wasn't looking forward to it. It ended up going fantastic, my tech was impressed by the small incision, and no complications! (until my tech sent me a text in the middle of this raid that the dog tried to scratch out her sutures, lovely.)

But- I offered a gastropexy, tacking the stomach to the body wall to reduce the risk should the dog bloat. Colloquially called bloat, GDV (gastric dilatation volvulus) is when the stomach fills (dilatation) usually with air though sometimes with food, and twists (volvulus), a condition more common in the large, deep chested dogs- great danes are the poster children for this, but we offer it for all large, deep chested dog spays. Gastropexy (stomach tacking) is tacking the stomach to the body wall so if the dog were to bloat, the stomach would not twist- the twisting cuts off blood vessels. The decreased blood supply to the stomach, spleen, and gut can be really dangerous- it only takes a short time for the intestines to die once their blood supply has been cut off. Gastropexy makes bloat a little bit less dangerous, since the stomach doesn't twist, just bloats, which we can decompress without surgery. Otherwise GDV is a surgical condition, with (depending on a few factors) a potentially poor prognosis. I will always offer euthanasia as an option for GDV. If you can't do surgery, euthanasia is the kindest thing to do.

Anyway- I was glad the client declined the gastropexy. I was really stressing out- I had a bad dream about work stuff related to the gastropexy, I was worried my nurse would forget to offer it, and then I was worried I'd forget to quote the cerenia (anti-nausea medication). After tacking the stomach the LAST thing I want is for the dog to vomit, and tear all my sutures out. I was watching videos I've only done 2, and none solo) and then the client declined. And I was relieved. I would not have to miss lunch with the unexpected extra surgery time for this dog, since the schedule was poorly done that day, and it was a Friday which already goes to hell most weeks.

Woo, Shad'har down! Writing this from Hivemind's floor now.

And it's been eating at me- am I a bad doctor for being relieved that the client declined a procedure that is in the pet's best interest long term? And this is not the firs time- I HATE pulling teeth, especially broken carnassials (the really big teeth at the back). Diseased teeth that are about to fall out anyway? Sure, I sometimes remove them free of charge with "aggressive cleaning" but extracting broken teeth sucks. I tell people who ask me "Do they really have to come out?" that the phrase "it's like pulling teeth" exists for a reason- pulling teeth sucks. So sometimes I'm relieved people decline- and most of the time it'll be fine, but the worry about tooth root abscesses is real so I do go over the signs to look out for. But is it a bad thing that I am occasionally relieved I don't have to to these procedures?

Intellectually, I know there are doctors out there who refer for anything they don't feel comfortable for, which in some cases includes things I find simple. And I did offer, and was willing. So I don't feel bad-I totally would have done the procedure. I may not have gotten lunch, but it would have been done. But I didn't need to.

I will have to remember that I offered the best care for the pet, and the owner declined. The old phrase, you can't care more than the owner does, comes to mind. I just want to be super!doctor some days, and I'm not. Most days I feel like acceptable!doctor, and continue to work towards being the best veterinarian I can be. And no one knows everything. That's why we have specialists to refer to and learn from!

And now, onto WoW woes! First, the lag tonight was real- repeatedly lagging out on bosses. We did get a new boss down, so yay there. I'm still struggling with feeling useless- no longer a raid leader, never a good healing lead- I made one attempt and gave up when the raid leader came up with a better plan. I've always been a fly by the seat of my pants healer. I used to do 10 mans, with the same 3 healers who I knew well, so I knew how to anticipate CD usage. And we never really assigned anything. In mythic, assignments are needed. Our raid leader off spec does whatever we need, but mostly heals. And does it on disc- which I suck at. I am trying to learn- I believe I resisted mostly from stubbornness, but also discipline just does not click with me. I did challenge modes as disc way back in Mists of Pandaria, when it was really easy. Now, it's something I have to pay attention to constantly to do moderately decently, where as every other healing spec I do takes way less attention. And from a contrary point of view- I love my resto druid. At the start of the tier I really looked forward to playing resto. Some drama with a new guildie who was promised the only resto spot (may discuss someday- old news, not important) meant I swapped. And we did not have a healy priest. And the leader that that time (not me, not the current one- also old news, may discuss someday) thought a disc priest would be good. Really everyone did. So of course I couldn't play disc. And it just doesn't click, and I have limited time to learn. I'm working on it now though! Angel of death announcing when I failed is not fun.

I forget where I was going with that thought- that I struggle with a role in the guild that I am an officer in in WoW? That I feel unneeded in a raid I used to lead in said guild? I am glad not to be in charge anymore- our current raid lead does much better than I ever did. Which some days also makes me feel bad. But most days I am glad about that. And I try to remember people have different strengths, and I probably bring something to the table, even if it's just putting down the feasts/making the cauldrons.

But for now, I am going to stay up a little bit later than I should doing some mythic plus, since tomorrow is going to start with an early appointment (going in 45 min early) for a quality of life appointment (read: probable euthanasia) for a patient of mine who is basically on palliative care. I am sure I will write about her later.

Something Educational?

I wanted to do a post that was a bit educational instead of me usual rants, but I'm not sure I succeeded. Here's a list of  random thoughts from your friendly companion animal vet. Some things we just can't say to clients, no matter how much we want to.

-I don't care where the drugs your dog ate came from, I just want to know if your dog could have gotten into drugs. I do not report anything to authorities.

-I love your pet. I want what is best for your pet. But I can't care more than you do, and I can't make decisions for you.

-I do not recommend heartworm prevention or flea and tick prevention to make money but to protect your pet. I also do not recommend it to make your dog sick so you have to spend more money. (Fleas are gross, and seeing one makes me itchy) And did you know 10 years of heartworm prevention is cheaper than going through the treatment once? Not to mention so much easier on the dog.

-Muzzles are just a tool and do not mean I think your dog is a bad dog. Same with oral sedation and cats- I do it to save them and my hands. Please don't make it harder on your pet because you think it reflects badly on you or them.

-It is not my job to make sure you bring your pet in where they are due for basic preventative care. We do our best- oh boy do we, with phone calls and e-mails and things mailed to you that your dog is coming due/past due, reminders on your invoices. I cannot make you come in for the appointment though, so don't get mad at me when you miss it and need to repeat something.

-I do not do vaccines to make money. I do it because I believe your pet will benefit. Vaccines are not some money making scam. Parvo is real.

-It is not my job to look up what vet in whatever city you lived in 5 years ago to get your cat's vaccine history. And if she hasn't been back to a vet in 5 years, she needs her rabies anyway. I do sympathize with this one- if I didn't work at a clinic, I imagine I'd have a much harder time keeping track of my pet's records.

-Your dog did not give your kid strep throat. Human doctors don't always understand zoonotic things - yeah that kitten probably did give you ringworm though.

-Please, ask me if you have a question. No question is stupid; I want you to be involved and knowledgeable about your pets care. I absolutely want you to trust my decision ,making, but I also want you to know why we give things like lepto vaccines and heartworm prevention. We are here to educate you.

-We do not keep a jar of fleas in the back to put on your pet, it came in with fleas.

-It's great the allergies improved on the medication! Of course they came back when you stopped it, do human allergies disappear after a single dose of allergy medication? No, you keep taking it daily. It is so much cheaper to manage allergies and prevent flare ups than to come in and treat chronic ear and skin infections from poorly managed allergies.

-The internet is not always right.

-Just because someone works in a pet store does not mean they are a nutrition expert.

-If your dog is limping- NOT USING A LEG- that leg is painful. Just because they are eating and their tail is wagging does not mean they are not in pain. Do you eat when you're injured? Or laugh?

-Taking pain medicine does not mean your dog is weak. Your dog is not getting addicted to the dog version of ibuprofen, ok? Just give them the NSAIDs please. And call us before giving them over the counter stuff- ibuprofen is BAD for dogs.

-If you can't touch your dog's feet, why do you think I can trim his nails? I'm a scary stranger, and you want to make today worse by having me try to cut his nails?


That's it for random vet comments, before I just start getting snarky. For WoW; Mythic Shad'har progress tonight, woo! I must learn to play disc priest, so the holy angel of fail doesn't make it obvious when I die. Alternatively, I can learn to, you know, not die to stupid. It's an ongoing process.

Re-Introduction

Hello! A lot has changed in the years since I started this blog, and after a few year hiatus, a re-introduction seemed like a good idea.

Hi, I go by Nala here on the internet. I'm a small animal veterinarian who works for a large corporate practice, and in my spare time I play World of Warcraft.

I still consider my self a doctor in progress. One of my favorite things about veterinary medicine is there is always more to learn, more to do. You can always go learn something new, some new procedure, some new way to help your patients.

Last year, my big learn was acupuncture. I have an older lab, and I want to keep her comfy and happy forever. Since I know forever is not feasible, as long as possible is my goal. Acupuncture can help with pain control with arthritis and really everything. When I finished my training, I kept thinking, there's a point for that! But I definitely  don't use acupuncture as well or much as I could.

Cause I'm still in progress, and a wimp and scared of failure sometimes.

I thought about doing "a day in the life" but someone already did it much better than I could. She does talk more about the burn out and suicide rate than I perhaps would  have, but it is fantastic. Here is the link to Dr. Bowden's talk.

That's a good, typical day. I went from back to back euthanasias today to a new puppy appointment. It happens frequently. I don't have a phone call slot- I have to work that around appointments. Otherwise pretty similar. We all have our Ollie stories. Some are a success. Some are a failure. And I will carry those with me. And honestly, I worry that the day I don't take those thoughts home with me is the day I just won't care anymore, and should stop treating patients.

Today was a harder day at work than usual. And I came home to my hobby, WoW. Where we're starting mythic work, yay! And we're struggling to get 20 people, have to fill in. And we're working on a new boss. And I just want something mindless that I can be good at, but it's not quite working out.

In WoW, I am an officer in a fairly new guild- been around about 9 months now? It seems like longer since I've known most of the people for years. I've stepped down from raid officer, for someone who kinda blew it off with his real life responsibilities, and some one else stepped in.

And in some ways that also makes me feel like a failure. He's a great guy, and doing a way better job than I ever did. But the support that was given at the start of this tier- and frankly wasted by the guy who wanted the job at first- I was just so conflicted about. Was this help always there, and I didn't ask for or see it? Was it only there now because I wasn't? Was I a failure? Am I bad at this game I've played for so long?

Then I realized I was in a downward cycle of depression. And I spiral up and down, great some days, so unable to bring my self to do the simplest things other days. And some days the fact that my help isn't needed or wanted puts me in a bad place, and some days I'm grateful that I don't have to do anything. And some days I worry that people don't like me, and some days I remember that I'm an adult and who the hell cares?

So I'm a doctor in progress and working on being a healthy human being as well. That last part is such a work in progress. Sleep, eating well- it's tough. The fact that we have a candy bucket at work doesn't help. Though someone did put a few apples in it, which was a nice gesture that I am sure we will ignore in favor of the starburst jelly beans.

So that's me- a messy, emotional ball who will spend a lot of this blog worrying over a variety of daily life issues that plague me. I may occasionally attempt an educational piece, or just an update on progress.

Mostly, this blog is for me- I hold so much in. I haven't told anyone in my support circle about how tough today was, aside from a note that we should celebrate Cinco de Mayo with some margaritas because today was long. And I don't know if I should tell the woman who was crying at her dog's euthanasia with her sons out in the car, when I write her sympathy card, that on post-mortem exam it appeared to be oral cancer and she absolutely made the best decision for a likely untreatable condition. The location of the tumor would make surgery really a bad option, and he was 15, with a heart murmur, cryptorchid with one testicle larger than the other, and a host of other problems. I already told her she made the least selfish decision she could, and that treating him would likely not have helped and been really tough on him. But I didn't know about the tumor until after she left, and I don't know how to tell her now, if it would hurt or help. But these thoughts and experiences are what keep me in progress instead of stagnating.

So I will sleep on it, with a good margarita from my favorite Mexican restaurant, and write again later.

Good things

Things were very negative last post, and tonight for me is  being dragged down by some pessimism, so I'm going to recount the good things that happened this week.

We successfully killed a new mythic boss, Maut, and started working on Hivemind.

My priest has usable weak auras for Disc, and I feel like I might be able to really learn to play it. I was also told I don't need to, which relieves a lot of pressure about playing it.

I did my first cherry eye surgery today! Than you so much to Dr Abrams and his awesome video that totally saved me! The dog presented for a neuter with a cherry eye, and when we called her about it she authorized repair.

My favorite co-worker might be back next week! She's pregnant and has been out for 2 months after getting the flu, coughing so hard she broke 3 ribs, and the corona outbreak. I might have my lunch buddy back really soon!

We had 2 separate instances of free food today. A lovely client had edible arrangements sent to us, so some of it was even healthy!

I had a successful, no complications spay this week too, after 2 bad ones last week.

And even with 2 days of crappy eating my weight hasn't gone up yet!

Those are the big ones I think of when I think of good things this week. There were lots of puppy snuggles as well, and only one incident of anal glands on my clothes, so I'll take it as a win so far.

One day left to do in the week, and no more plans that require me to have real brain power.

Next week I'll work on why I feel useless in WoW, and why I feel like I've been a bad doctor lately. But can only handle so much self-reflective negativity at a time before it all spirals down.

Bad Days

It seems like lately, every day has been a stream of small, bad things. By themselves, nothing concerning- a surgery complication, but managed. A busy schedule. A missed lunch. Discussing surgery complication with the owners. The corporate people breathing down our necks about profit. Telling people that their dog likely has months left. And sick pets leading to euthanasias. And that is my topic today.

I do not mind euthanasias, I seriously looked into a job in hospice at one point. I do not feel like euthanasias weigh on my soul- for the most part. The ones that do, are the ones I wonder- Did I make this worse? Did I give these people false hope, and make this pet suffer through painful days? Did I give these people too bleak a picture, and treatment would have worked? And the ones that I try not to think about, the ones I perform where I know the pet has a treatable condition and could have a loving home somewhere, with time and money, but the time and money just aren't there. And my personal thoughts for those ones is if I  won't take the pet home today and deal with the conditions, and I don't have anyone able to do so, euthanasia is viable. But those are the ones that hurt- the ones that just needed time and treatment, or the fear that I made an animal suffer through painful days needlessly for a recovery that was never going to happen.

And then there are the ones, that while they don't leave me doubting, don't leave me questioning my every decision in their care, that take so much out of me. The ones I have known and treated for years. The spicy cat that just laid there in front of me after not eating for days with the tumor in her abdomen. The old lab who just can't keep going for her people anymore.

I lost a patient today. Lost isn't really the right word- I ended her life. As I have done for many pets in the past, and will do for many in the future. But today, the barriers that let me compassionately help this cat die a peaceful death then let me leave the exam room and be the smiling, knowledgeable doctor excited for the new puppy that is my next appointment were just gone. Holes torn through them by a myriad of small stresses over the last few weeks. And the always constant question, did I do right by this cat?

I lost a patient today. To heart failure. She hadn't been to our clinic in a few months, but with the corona social distancing practices, I told the owner to bring in a urine sample for the UTI he thought his dog had, rather than having her come in. She came back a week later, in CHF. And was euthanized at the ER the next day.

I lost a patient last month. It was the first time I met him, but I'd treated his family's other dogs for a while. He was older, and had some neurological problems, and it was tool late to help him now- he'd reached the point where the owner wasn't willing to try. And he was a tough euthanasia. I could not get a vein, and he ended up being my first intra-hepatic euthanasia. I had not prepared what to say yo the owner in advance as I have for my usual euthanasia. I could only describe what I believed would happen from lectures and reading. And I had to convince her that he was not suffering for this, to her, non-standard way of euthanasia.

I lost 2 patients last month. And their owner brought in presents for me and my tech the next week. And they were so sweet, and absolutely did not deserve to die. But they had been deemed dangerous, and their owner was forced to euthanize due to court order, and she did not have the money to fight it. So at her request, I euthanized two young, physically healthy dogs, with animal control waiting out side to make sure we did. 

Euthanasia is an important part of my job. It is something I strive to make peaceful and comfortable for the pet and client. But some days, I don't know how to make it peaceful for me. I absolutely knew, with my cat patient, that her quality of life today was terrible, and prolonging things would be a cruelty. But could surgery last week, when we discovered the problem, have fixed it? Or last month, when I thought, her abdomen feels odd- but was never able to recapture that feeling on repeat palpation? And could I have caught something having the dog come in to check her urine, instead of just a sample? Started her on lasix earlier, or at least talked to the owner and learned that she had been coughing since December, he just didn't think it was a big deal.