Speaking of emergency ...

I found this great blog entry today containing tips for dealing with veterinary emergencies (as an owner/client).

Same situation, VERY different response

Once in a while you have a complication with a patient under anesthesia. I have now twice seen instances where a cat, while under anesthesia for a dental, developed a cardiac arrhythmia. (For those who care, they started getting individual VPCs and then developed into runs of them.)

As you may imagine, abnormal heart rhythms are a pretty big concern for us because they sometimes lead to death.

In both cases we aborted the dental and woke the patient up from anesthesia. Fortunately in both cases it was during the scaling (cleaning) part of the procedure and not during any extractions (surgery).

Case #1 at the corporate practice - I talk with the owner. Owner's response includes questions such as the following:
"So we used up the dental on my plan and I can't have it done until next year now?"
"Why couldn't you just finish?"
"How much would it cost to see a cardiologist?" (Ok, this one is a fair question but it illustrates the mindset of the owner - greater concern for money than for their cat - or at least that's the way it appeared!)
I had to bite my tongue from saying to this owner "So you wanted your cat's teeth cleaned even though he could be DEAD with clean teeth?!?!?!"

Case #2 at my current practice - my colleague talks with the owner (it wasn't my case this time.)
Owner's response:
"Thank goodness he's okay!"
"What should we do next to find out why this happened?"

Which owner would you rather work with?

Emergency conference

A few days ago I returned from the IVECCS conference in San Diego. It was fantastic! There were 7 or 8 different learning tracks ranging from complex specialty center care (ventilators and the like) to things useful for a general practitioner like me. There was also a technician track with 2 different lectures to choose from at any given time.

Here are some examples of the lectures I went to:
Anaphylaxis
Lymph node cytology
Blood smears
Respiratory distress in cats
Anesthesia for patients with pre-existing disease (heart disease, diabetes, etc.)
What's new in the treatment of parvovirus infections

In addition to the excellent learning content, I got to catch up with many of my friends from my old hospital where I was a tech as well as friends from vet school. I also had time to visit the San Diego Zoo, Sea World, and to go to this crossfit box for a workout!

Here are some of my favorite pictures from the trip:

Turtles at Sea World

Flamingoes at the zoo

Manta ray at Sea World

Hilarious!

Next year the conference is in Indianapolis. I'd love to go again but may choose a different conference such as a feline-focused one.

How veterinary medicine ruins food

The other day I saw one of the worst ear infection cases I've ever seen. While cleaning out the foul-smelling sticky yellowish-white gunk from the dog's ears the tech commented that it looked like Alfredo sauce.

Eww.

We make a lot of comparisons to food in our field because the various things that come out of our patients resemble food items. These comparisons also make it easier to converse with owners and to get a good description of vomit, diarrhea, pus, and so on. Some examples:

- The diarrhea from patients with hemorrhagic gastroenteritis looks almost exactly like raspberry jelly (but smells NOTHING like it)
- Diarrhea can be liquid, "milkshake," or "soft serve" consistency
- Ear mite debris and vomit containing digested blood can look like coffee grounds

Eventually you get used to it, although it may be a while before I eat fettuccine Alfredo again.

It worked!

I'm still surprised from time to time when my treatment plans actually fix a problem with a patient. It seems to be those cases where I have to reason my way through the case and make up a plan for something I've never seen before. Since there is absolutely no way to learn a rote approach for every single possible problem in veterinary school you have to go back to basics and think your way through a lot of problems from scratch.


I'm also (sometimes) surprised when my clinical suspicion is later proved to be right through diagnostics or through a specialist referral.