Thursday, May 28, 2020

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!

Wednesday, May 13, 2020

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.

Wednesday, May 6, 2020

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.

Tuesday, May 5, 2020

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.