Starting surgery (again)

I've been getting 1-2 surgeries per week fairly regularly at work now, which has been nice. The past 2 weeks I've had 1 kitten spay with 1 kitten neuter. I have the same on the schedule this week, and then next week ...

... a mastiff puppy spay.

I vomit a little in my mouth every time I think about it. As long as one of the boss doctors is in the building at the time I should be fine. I seem to be able to tackle tougher surgeries if there's a senior doctor on site, even if they don't scrub in. There is comfort (and confidence) in knowing that help is available, even if you don't use it.*

*Key point that ex-hairdresser-practice manager at my old job never understood!

Down time

As a veterinarian your entire day is spent interacting with people - coworkers, clients, and colleagues at other hospitals. As an introverted veterinarian, this is completely exhausting - especially when one or more of the people you deal with is, shall we say, high-maintenance.

It's REALLY important to recharge, otherwise you will completely burn out.

For the past month or so I've been teetering on that red line, so to speak. Between traveling, working extra days at the vaccine clinic, and taking care of household tasks, I'm pretty near fried. As a result my old friend anxiety is starting to show up again as that non-specific clenching in my gut.

I've been trying to force myself to do less - clean less frequently, not spend so much time reading veterinary-related material (the number of emails and journals I get is overwhelming sometimes), and do things like just watch mindless TV or just sit outside on the patio.

Let me tell you, this is HARD to do. My mind keeps coming up with endless things that I *should* be doing instead of relaxing. There is literally no end to the things you could learn in medicine, or the things you could clean or organize in a home. I'm the kid who earned ALL the merit badges possible in Girl Scouts because I wanted to finish, dammit, so intentionally saying no to doing extra feels like slacking.

Here are some things that I did/am doing to help:
- Quit the vaccine clinic (I have one more day and then I'm done). The extra money isn't worth the stress.
- Asking D to do more things around the house that I normally take care of (get groceries, vacuum, etc.)
- I am thinking about hiring a housekeeper. D is worried about someone having access to the house when we are away, so I could have them come clean while I am home.
- Also thinking about hiring pest control services to spray the perimeter of the home periodically so that I don't have to battle the near-monthly ant invasions
- Bought a season pass to my favorite ski resort

Hopefully I can get back on track. I'm terrified of getting as burned out as I did at the corporate practice.

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.