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.

New Year

A little late to talk about the new year, but here we go.

A brief reflection on 2017- lots of big things happened.

-I quit my job. That makes the second job I've ever quit for reasons unrelated to moving out of the area. And on my last day one of the assistants told me some lovely things about what the other doctor had said about me. Made me both really, really glad to be leaving and really sad. I think of myself as a likable, friendly person. The other doctor and I were merely colleagues, who barely talked to each other. Two introverts who made no effort, I had thought. That day I found out she likely had a bad opinion of me , both as a person and a doctor. Made me really sad, and a little angry that she never tried to talk to me about it. So very happy to have moved on to my new job.

-Started a new job! It took a while to get used to the other doctor asking my medical opinion- not used to that from my old place, but  a nice change. I was initially a little worried since several doctors I worked with had bad opinions of the doctor I currently work with, but so far we get along great and I love working with people who actually like each other. Plus, now I no longer work 6 days a week every week! That is my favorite part, time off.

-I bought a house! Sadly, my student loans are still more expensive than the house I bought. Not even close. But yay, I have a house! I now live 10 minutes form my job. No more hour-long commutes stuck in traffic.

Those are the 3 big things in my real life from 2017.

In WoW:

-My guild leader took a large step back due to health issues. He usually is less active as the expansion goes on, but he had to completely stop for a bit at one point due to health issues. We officers are currently trying to better hash out officer duties, more official guild rules than "don't be a jerk" and figure out the future of our raid.

-We lost a few good guildies from the game. Most to burn out, some to boredom. 

-The end is in sight! New expansion announced, I've hit 75 on my artifact weapon on 2 specs.

Current projects:

-Our guild rules/officer duties discussion

-Figuring out what we want to do with raiding once we clear the tier, and how to tell some people they just aren't hashing it in the heroic raid and should stick to open normal night. I suck at telling people no. 

-Finishing unpacking! At least by next Thanksgiving.

I'm Back! And of course, complaining

Wow, it has been some time. I have felt the urge to write, but it mostly strikes at work, and I don't want to do personal stuff on work computers. And blogging from my cell phone would likely be a pain.

Ah, work. I graduated! Full fledged veterinarian now, out and practicing for a year. I took a job with a shelter that also has a full service clinic for the public. I occasionally regret that, and occasionally really love it. I am looking for a different job due to work troubles- which may or may not end up another post. But today, this week, has been bad in work, job hunt, and WoW. With the triple whammy, I felt the urge to write my thoughts down.

The quick ones- 5 euthanasias in 3 days, the last one was an emotionally wrought emergency with a suffering dog we kept alive a bit longer than we should have in hind sight so family could get there, only to euthanize as they walked in.

Then Friday, I get notice that two of my patients have died. One expected, the other, while not directly my fault- the owners never came in for follow up care and instructions as directed, and never told me they wouldn't be able to, I still feel responsible. Because I had the option to send the cat home with a technician for care, and instead, happy the presenting people wanted to keep it instead of surrender, sent it home with them, believing they could care for it over night, and come in for further care in the morning if needed. So I indirectly killed that one.

I have been job hunting for several months, with little success. I turned down the offer from the first place I interviewed, which I think gave me false hope, since everywhere else has not worked out. Then I took a week off in September, for a few reasons, but one was to house hunt in the area where I am job hunting, believing an interview over the weekend went really well and I would get the job. House after I put the request in, was contacted and told they were not interested in hiring me.

That evening, raid time! Main tank and RL whispered me half an hour before the raid- sick, can't make it, can I run it? Sure, ok. Start raid up- we have a few guildies who like to get the Gul'dan thing. Tonight, they killed people as we zoned in. Annoyed 3 raiders (including our other tank and our strongest healer) and they just quit raid and logged. We ended up doing an alt run, unsuccessfully, with 2 alt tanks who were not geared well. Quit early. And I was pissed- at the people with the gul'dan antics, a bit, and they were talked to. At the people who up and quit without discussing any issues prior, I was furious. They said, later, the problems had been going on for weeks unaddressed- well, yeah, if no one tells me there's a problem, I don't address it. Leaving mid raid without comment was NOT the way I would have liked that handled. They wasted 15 people's time because they were annoyed at 2 people.

Still working out the raid situation.
I have amazing colleagues- posted about job woes and stress and had some instant responses. 

And I have new hope after getting a full night's sleep that next week will be much better.