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Clean bill of health…

Can we talk about the fainting schnauzer video? We need to talk about it, because if there’s one thing I don’t get in this world, it’s the current trend for pets with a myriad of medical malfunctions or genetic issues becoming internet sensations.

You’ve seen the video, I imagine. A dog is surprised by the owner she hasn’t seen in a year or two, and after freaking out for a few seconds she loses consciousness briefly.

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Attempting to head off criticism, Carson Daly helpfully interjects “CLEAN BILL OF HEALTH GUYS” into the video. No problem, dog is great, everyone can go home, right?

Syncope, Part 1

Now without knowing the dog or what went down at the veterinary clinic, I can’t really tell you what happened, but I can tell you in general that fainting episodes (what we term syncope) are not normal, no matter how excited a dog is. There is a pathology there, whether it’s cardiac or seizure activity or something, but “she just got the vapors” is not a diagnosis.

Let me share with you the general arc of a visit when a patient brings a dog like this- and I’m including both seizure activity and syncopal episodes here- to me. Because the episode itself is short lived, by the time the dog shows up to the clinic he or she often looks fine. After taking a history and keeping in mind things like the age and breed of the pet, we begin the examination.

“Well, the physical examination findings are normal,” I say.

We could end things right here, and you could read that as saying “The pet has a clean bill of health!” But that’s missing the fact that while physical examinations are wonderful tools, they are limited in what they can tell us. The causes of syncope are rarely evident based on physical examination alone.

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“If we want to figure out the underlying cause of the issue,” I will say, “We should begin with some bloodwork and a urinalysis.” The client may or may not agree, mentally calculating the cost.

“If that’s normal, and it often is, we could proceed next to a cardiac workup: an EKG/cardiac echo/24 hours on the Holter monitor and have a cardiologist review the results.” Now we’ve definitely ventured into “need to think about it” territory.

“If the heart is fine, and we’re more concerned about seizure activity being what’s going on here, a neurologist is your best bet. Unfortunately, diagnosis usually involves costly procedures like CSF taps or CT scans. Epilepsy? Well, we don’t have a definitive test for that at all, so we just have to make the diagnosis based on ruling everything else out first.”

Many owners, especially after a first time episode, go as far as the bloodwork and decide to wait and see if it gets worse before moving to the next step. I don’t blame them- it’s expensive, and you have no idea if the dog will have an event a day later or a year later- but I just want to emphasize that unless they actually performed all of those diagnostics I just listed, it’s hard to definitively say the pet truly has a clean bill of health.

There’s a reason “The dog’s fine!!” is in the Today show headline and Carson makes sure to tell you “the dog’s fine! Someone said so!” and that reason is, we all intuitively know things aren’t fine. Just because you haven’t found the problem doesn’t mean it’s not there. It just means you haven’t located it yet. And I imagine somewhere in that visit, between answering calls from the Today show and counting YouTube hits, the vet did say just that.

 

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Filed: Blog, Daily Life, Dogs, Featured Posts, Features, Health Tagged: ,

Live from Vegas: Pet Products You’ve Got To See

FTC Disclosure: featured products provided review product and/or compensation for inclusion in the Product Spotlight.

If you’ve ever been to a trade show, you know how easy it is to get overwhelmed. A pet show like SuperZoo is an utter cacophony of sounds, sights, and row after row of many things that all look the same after an hour: treats and collars, treats and collars, rinse, repeat.

szIt’s hard for products to stand out in a crowd like that, but when Dr. Andy Roark and I hit the convention floor the last couple of days that is exactly what we were looking for. Fortunately for us, we found it.

Like two wandering corporate souls in sensible shoes and dark suits, we crisscrossed the vast plains of the Mandalay Bay convention floor searching, talking to people, and petting booth dogs until we wound up with three fantastic standouts for the Inaugural Roark and Vogelsang SuperZoo Product Spotlight. Here they are:

1. Tech of the Year: Voyce collar

Remember that moment in Up when Carl says to Dug, “I wish he could talk” and Dug’s collar says, “Hi there”? The idea of our dogs being able to speak has transfixed us humans for years with the possibilities of what they could tell us: Are you hurt? Are you hungry? Are you tired?

While the Voyce collar can’t actually make your dog talk, it is a huge leap forward in the ever growing market of wearable tech for dogs and so far, the closest thing we have to speaking their language. The Voyce collar’s technology and interface tracks and trends over time not only activity level and calories burned but heart rate and respiratory rate.

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As someone vastly invested in the concept of providing better care for senior pets, one of the messages I keep trying to get across to pet owners is this: ‘he’s getting old and tired’ is only the tip of the iceberg. If your tired old man has a resting heart rate through the roof and pants 24/7, guess what- he may be in pain. This data, which up to now were only accessible by a person with a stethoscope, can be collected at home over time and accessible to both the owners and the vet.

To add value to the experience, Voyce teamed with education resource provider LifeLearn to ensure owners have access to a wide variety of educational resources to help understand the data and make all of us better pet owners through improved knowledge. The dashboard features not only your individual pet’s collected data but advice and articles from a large panel of  animal experts.

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There’s a reason it won the PC World/Tech Hive and Yahoo! Tech “Best of CES 2014″ at this year’s Consumer Electronics Show. It’s nice to see the tech world finally going to the dogs.

The Voyce collar will be launching before the holidays- interested owners can sign up on the Voyce website to be notified when it is available for sale online. In the meantime you can join the ever growing community on Facebook of techie dogs waiting for their chance to have a Voyce. -JV

2. Toy of the Year: Tuggo Dog Toy

It always makes me feel good to watch a big man dance. That’s the same feeling I get when I watch a big, strong dog play wildly with a toy. I think that’s why I am such a fan of the Tuggo Dog Toy.

The toy is wonderfully simple in its design. It’s a large plastic ball with a rope through it. The ball can be filled with water to add weight and cause a “tugging” motion. Dogs grab the rope, pull the ball around, and toss the entire contraption into the air.

To appreciate what Tuggo is, you’ve just got to see dogs at play with it. Tuggo’s Facebook page  is covered with videos of dogs enjoying the toy. Here’s the video that originally caught my attention:

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I love large dogs, and one of the greatest struggles I see pet owners having with them is getting them enough exercise. While small dogs can often work out inside the house or in the back yard, large dogs may not have the space to adequately stretch their legs. If a product like Tuggo can get these big dogs out and moving and burning calories, then I’m all for it. And who doesn’t like watching big dogs frolic like puppies?

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The ball is available in red, blue, and green colors, and in 10-inch diameter and 7-inch diameter sizes. Tuggo Toys can be purchased through their website  and shipping is free.   -AR

I asked founder Adam Harrington what inspired the Tuggo, and he told me “watching my dog play with a bowling ball.” All of you people asking me for a TOUGH toy? Here it is. -JV

 3. Lifestyle Product of the Year: Kinn Kleanbowl

As a busy mom, I have to tell you: things that make my life easier make me very happy. We eat on paper plates a lot around here. While I am tempted by the ease of doing the same for my pets, if you’ve ever watched a dog try to eat out of a paper bowl you know that just ends in upended bowls wedged under a chair and food embedded in the kitchen floor, so stainless steel it is.

Here’s the bad news: according to NSF International, pet bowls are the 4th germiest place in the house, teeming with E. coli, Salmonella, yeast, and mold. This is exactly what you would expect when you leave a bowl of meat products sitting around. People? We’re lazy and don’t wash the bowls nearly enough, and that is just how it is.

Here, in an elegant form, is the solution: the Kinn Kleanbowl, a stainless steel rim that sits on top of a sturdy, compostable bowl made from recyclable yet sturdy and waterproof (yes!!) sugar cane fiber. Yup, you can use it for water too, so you eliminate that algae-goo that builds up if your bowl doesn’t go in the dishwasher every day.

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My cat eats a lot of wet food and Brody get rehydrated raw, so we know all too well how dirty and crusty bowls get. That being said, oily kibble residue isn’t much better. In addition for being a boon to time starved people like me, the Kleanbowl is a great solution for busy vet clinics who need their staff to spend less time scraping uneaten leftovers off in the trash and more time replacing the catheter the dog in cage 4 chewed out, yet again.

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There is a small but persistent voice in my head that wants to know how this would also work with toddlers and spaghetti.

Clean. Convenient. Compostable. This is a bowl for  the people. The Kleanbowl retails for $19.95 and 50 count refills are available for $14.95 at the Kleanbowl website. To keep up on all the innovative products from Kinn including what I believe to be the world’s finest pill splitter, check out the Kinn Facebook page. -JV

 

Any of these jump out to you as must-haves? Stay tuned. Andy and I are going to be running a giveaway very soon!

Filed: Blog, Featured Posts, Features, Lifestyle, Pet Gear, Reviews Tagged: , , , ,

Cures what ails ya

In the olden days, people used to turn to carnival medicine men or the back pages of Look Magazine for the latest way to solve all of their problems. People don’t change, just the technology. Now we have the internet to turn to. If the web is to be believed, and it always is for some reason, there is a new cure for all the world’s ills. That cure is coconut oil.

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It’s good for your hair, your skin, your GI tract, your dog, your mental health, and your aura. It’s anti-inflammation and pro-synergy. You can rub it on your scalp, then scrape it off and use it to cook, or sit on the leather couch and make it more supple. I don’t think there is a single malady out there that someone has not suggested coconut oil can fix:

Dry skin? Coconut oil.

Dry face? Coconut oil.

Yeast infection? You guessed it.

Alzheimer’s? Eat up.

Athlete’s foot, acne, depression, hemorrhoids, anxiety, UTI, weight loss, heartburn, autism. I guess what I’m saying is you could nuke your local CVS and be just fine as long as there was a Whole Foods next door, because coconut oil’s got you covered.

I’ve done a Whole 30 challenge, which is a no-processed food crossed with a tinge of Paleo, so I’m no stranger to coconut oil. I’ve cooked brussels sprouts in it, stirred it in my coffee, used it to make paleo pancakes. They were good.

Sadly, at the end of a jar I have to say my life has not substantially changed. Everything broken in me before is still broken. Coconut oil, while delicious and no doubt healthier than, say, margarine, has not eliminated my need for my allergy inhaler. I asked my doctor if I could try shoving coconut oil up my nose instead, just for a little while. It’s way cheaper than Dymista. She didn’t think much of the idea. When I told her I was just joking, then she sighed and said, “I get that question a lot.”

While coconut oil is unsurprisingly gaining steam in veterinary medicine, we have an equivalent that already enjoys legendary status in the home remedy category: pumpkin.

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Long treated as the pet pepto-bismol, pumpkin is the go-to far various GI maladies spanning the range from constipation to diarrhea. It’s a great thing for the colon. It’s a great source of fiber and most pets will eat it. Pumpkin is Metamucil in a more holistic package.

What pumpkin is not is everything else, like an anti-emetic or anti-inflammatory or something that will teach your dog to talk. Like, it’s no coconut oil or anything.

On a friend’s Facebook page, she recently asked if it was possible for a pet to develop an allergic reaction to a food they’ve been eating for years.

10 people chimed in (correctly) that yes, this happens. Then someone said, “Why do you ask?”

“Because my dog’s been throwing up every time he eats all of a sudden.”

As a veterinarian, my mind immediately collates a list of the differentials when I hear something like this. 3 year old pit bull, history of being a destructive chewer, clearly the problem is “pumpkin deficiency.”

Which is exactly where the comment thread went.

“OMG! You need to give your dog some pumpkin.”

“Seriously! My dog loves it.”

“Pumpkin cured my dog’s farts.”

“Pumpkin is a great source of electrolytes.” And so on and so forth.

Don’t get me wrong, I like pumpkin. As far as advice on the internet goes, it’s one of the more benign things I’ve read and unlikely to cause harm. My only concern is that people recommend this in lieu of something that might actually work, such as starting with a correct diagnosis. Fortunately this person has multiple veterinary professionals on the thread, and somewhere in between pumpkin recommendations she got some solid advice.

A couple of weeks ago, my neighbor came over with her adorable 6 month old Golden Retriever. She hopped back and forth on her toes before asking me if I had any thoughts about her dog’s diarrhea.

“How long has it been going on?” I asked.

“Two days.”

“Go to the vet.”

“We’re going tomorrow,” she said, “but in the meantime……do you have any pumpkin I can borrow?”

I did. It’s on the shelf next to the coconut oil. Hope springs eternal.

 

PS The dog improved dramatically … once the vet diagnosed Giardia and started Flagyl.

Filed: Blog, Cats, Daily Life, Dogs, Featured Posts, Health, Musings Tagged: , ,

Dog: World’s Worst Coach

I am training for a half marathon.

I thought about training for a full marathon, but then the reality what that was like the last time I attempted it kicked in and I remembered that oh yeah, I don’t like to run. I think you can do a full marathon once when you don’t like to run, just to say you did (Rock n Roll 2001 for me), but after than there’s really nothing to prove other than, “oh yeah, this hurts.”

A half marathon though, is doable. Still not fun, but manageable. I have decided, along with my friend from the gym who I kind of hate because she keeps inviting me to things such as “Summer Boot Camp!” and “Half marathon! It’ll be fun!” and I keep saying yes, that should we complete this without killing ourselves, maybe, just maybe, we will try and tackle a triathlon before our 40th birthdays.

Do they let people leisurely triathlon these days? All my competitiveness gets used up in my professional life so I have none left over for this.

Anyway, the point is I am doing this and it’s a grind, but I keep remembering that health is a gift and blah blah blah; I’m training with a group because it’s the only way I will drag myself out of bed at 6 am for the long Saturday runs.

Brody doesn’t come with me on those. He can manage shorter distances, but he’s made it clear he’s not yet ready for anything over 3 miles, tops, despite his summer cut. I appreciate that.

This Saturday I ran (‘ran’?) 9 miles, which sounds alternatively fantastic and psssshaw depending on where on the running spectrum you fall. To me, this is the longest distance I’ve done in a single day since I staggered off Mt Meru a few years ago, and that was because I had to since there was no oxygen up at the top.

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I’m hunched over because I couldn’t straighten up, not because I voluntarily felt like standing that way. Teri is hanging on for dear life.


 
So after 9 miles, at the end of which I realized my entire body was numb from the waist down, I came home and sat on the floor to stretch. Soon enough I was laying on the floor, like one of those crime scene outlines.
 
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020 0120 7141 023 0123 7173 Small is Beautiful Floor Black Still Life, by Steve James on Flicker

I began to appreciate why dogs do this, this splat sort of positioning. The wood was cool. Soon I melted and became one with the floor. Why don’t I do this more often? I wondered, and when my daughter asked me why I was doing that I realized it was not really possible for me to make it onto the couch at that particular moment.

Brody was excited I was in his domain, plopping down nose to nose and looking at me like, “Hey! What are you doing here?” He stared at me for a while, and then I decided I needed to stretch if I ever was to have hope of standing up again.

It went about as well as you’d expect.

Dogs don’t understand why we would come into their territory for any purposes other than play, and Brody was having none of it. He laid on my foot, licked me in downward dog, and dumped a soggy tennis ball on my stomach when I tried to stretch out my hip. It’s clear I’m not alone in this.

Dogs are awesome at many things, but sitting quietly by while you sit on the floor and bend into weird shapes is not one of them. If you’re going to goof off, they figure, might as well let me in on the fun.

Anyone else have a dog who simply won’t let you on the floor by yourself?

 

 

Filed: Blog, Daily Life, Featured Posts, Fit Life, Goofball Antics, Health, Musings Tagged: , ,

Good health is a revelation

When I took my son in for his first routine eye exam, I had no idea he needed glasses. Neither did he. He seemed fine, wasn’t running into things, was reading fine in school, but nonetheless the optometrist suggested glasses. OK, I said, let’s give it a shot.

One week later, his glasses arrived and we went into the office to pick them up. He picked them up dubiously, slid them over the bridge of his nose, and stood there for a moment, blinking as the refracted light hit his retina in new and improved ways.

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He spun, slowly, taking it all in. His lips twitched, burbling with something important. When he could no longer hold it in, he opened his mouth and shouted, “I CAN SEEEEEE!!!!”

Boy did I feel like a horrible mom as the assorted clients turned to see this blind boy get his sight back.

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Later that week I was sharing this story with a friend. As we were talking, her daughter picked up my kid’s glasses and put them on just for fun to see how weird things looked.

She came over and tugged on her mom’s sleeves. “Hey mom. Things look pretty good with these things on. I think I can’t see too well.” Then I felt less bad. It happens to us all.

We thought things were fine, my kid thought things were fine, and then someone with tools I didn’t have access to and the ability to evaluate things said, “Actually, life can be even better.” And it was.

I think of this all the time when people say, “Oh, Buster’s doing fine, he doesn’t need an exam or meds or anything.” To a client’s eye, he is fine. His gait is the same it’s always been. But I can pick up things they don’t, that slight crunchy feeling in the knee, a stiffness when I extend the leg. It took some doing, but we convinced that lab’s owner to try some Rimadyl.

Or the dachshund who came in for a routine dental. “He’s fine,” the owner reported. “He eats kind of slow but he’s been that way since we adopted him two years ago.” When we opened his mouth, the fetid odor of eight rotting teeth hit my nostrils, teeth held in by tartar more than by tissue at that point. It took some doing, but we convinced the owner to let us remove them.

In both cases, we got a call about a week later to marvel about this new dog in the house. “He’s like a puppy again! I can’t believe his energy! Who IS this dog?” Like my son spinning around in the optometrist office, they had a problem they didn’t even realize existed lifted from their shoulders, and got to experience something better for the first time.

In the year since their last eye exam, both kids seem to be perfectly fine, but I took them in dutifully anyway. Both of them need new prescriptions. This time, I don’t feel so bad. Big things we notice- small ones? Not always.

It isn’t my job to evaluate such things in my kids, or to be able to recognize the more subtle signs of something needing help. All I need to do is get them to someone who can, on a regular basis. Next stop: orthodontist. Lord help us all.

Just a little reminder to everyone that there is a reason we recommend yearly (twice yearly, for older pets) checkups at the vet. We’ll probably find things you weren’t aware of, and that’s OK. That’s what we’re here for! Every pet deserves the revelation of improved health. :)

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Filed: Blog, Featured Posts, Health, Mother of the Year, Musings Tagged: , ,

Arya of House Potcake

One thing I’ve learned about going on vacation, is that I don’t like to relax.

How can I, when there’s so much to do and so little time! I want to see ALL THE THINGS!

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And most of the time I vacation with my husband he responds with a blank stare and a “why would you want to do all of that?” So this time around we went to Turks and Caicos, a small island chain in the Bahamas whose island upon which we landed is only 38 square miles, so I think he assumed he would have me boxed in by water and I’d have no choice but to chill out.

He was wrong, of course. Shortly after arriving, I spotted the telltale signs of what I knew to be an island without an animal control program: stray dogs darting across the street, hiding from the midday heat and humidity in whatever shade they could find. In the Bahamas, these distinctive stray dogs are called potcakes, after the congealed rice and pea mixture scraped up from the bottom of the pot that was traditionally fed to the dogs. Scrappers from the start, these sturdy little guys.

With no official animal control and a population subject to the elements, starvation, parvo, and heartworm, one of the ways to deal with them was through poisoning (a very common and unfortunate way to cope when there is no program in place to help the animals.) Potcake Place is a rescue located on the island, 100% volunteer run and donation based, that exists to help bridge that gap and give these dogs a chance. Visitors are welcome to come in and meet the pups, so of course within 24 hours I mapped the place out and planned a trip.

I wasn’t sure what I was going to find, but I sure wasn’t expecting this:

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What they have managed to make out of so little is truly heroic. Enjoy the pictures of these healthy little pups. I guarantee you, before these rescue volunteers took them in they were not this happy and healthy.

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The facility is cheery, tidy, and full of happy. It makes people WANT to go in, as evidenced by the steady flow of tourists into the building to play, learn, and offer to courier the dogs back to the States. As the bulletin board shows, they’ve been successful in that as well.

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(aside- one in Hawaii?? That’s hardcore.)

Best souvenir ever, right? These people all seem to think so.

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Knowing this was ABSOLUTELY NO NO NO out of the question that we would be able to take a dog home, I settled for the next best thing: Potcake Place allows you to be a ‘foster for a day’, taking a dog out and about to give them socialization, exercise, and an opportunity to show off for more tourists on the street.

Who’s available? I asked.

They said, Bran, Rickon, and Arya. Was this meant to be or what? So we borrowed, of course, Arya.

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Come on. This is totally relaxing.

So anyway, we spirited Arya back to our little stretch of beach and told her all about the world. How people are pretty cool, if you trust them. How she should enjoy this water while she could because rumor had it she was on her way to Boston on Saturday. She took it all in stride.


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Did I mention Arya is extremely photogenic? I hope she goes to someone with a blog. Almost as much as I hope she goes to a Game of Thrones fan.

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And she’s great with kids. Seriously, she was awesome.

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So awesome, in fact, that when I saw her in the airport departure lounge on her way to a no kill shelter in Boston I seriously considered changing her out with my neck pillow- they’d never know until it was too late. Cooler heads prevailed, of course, and I decided I would instead focus my efforts on trying to convince them to put in an application for a World Vets team to come and help with a large scale spay/neuter effort.

I know just the right vet to help out.

 

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To learn more about Potcake Place, visit their website or Facebook page. They adopt to people all over the United States, even those who have never been to the island; you put in an application, and once you are approved you wait until someone from your area goes there on vacation and volunteers to courier the pup back to you. Isn’t that a great system?

Filed: Be The Change, Blog, Daily Life, Featured Posts, Happy Tails, On Safari, Photography Tagged: , , ,

Restful dreams, Red King

I once worked in a very stressful place. It was an emergency hospital, always about 3 staff members short of a full crew and 25 people piled in the lobby waiting for treatment. It was a large staff of doctors, about 10 at the time, and as how things tend to happen in nutso environments the staff would get nutso a little bit as well. Stress does that to people.

You never sat still at that hospital; it was run run run, a dog bleeding out in room 1, a dyspneic cat gasping in room 2, five clients wanting updates on the phone. We didn’t catch up on things there so much as run as fast as you can so as not to fall further behind. The whole place had a surreal Through the Looking Glass feel to it, now that I think about it.

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In the midst of this chaos, one or two of the more enlightened veterinarians managed to float above it all. Dr. Naidus was one of them. Needles would be flying and people screaming and papers falling to the floor, and he would be solemnly nibbling on some healthy snack or another, surveying the scene with an amused glance before going back to whatever it was he was doing.

The interns and newer veterinarians such as myself were drawn to him like an acolyte to a guru, trying to figure out the secret of his zen-ness. He’d laugh and tell us when we were old we’d be too tired to get worked up over the small stuff too. (He was right.)

Clients loved him as much as we did. Every Christmas, when I considered myself lucky to get a hand soap from the rare client who could remember my name, baskets would start showing up in the treatment area with his name on it. Baskets and baskets and baskets. He always shared.

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Dr. Naidus got more gifts than the rest of us put together, including the owner and the boarded surgeon, and when we tried to figure out the secret of people loving him as much as they did it was simple: he gave them what they wanted. Treatment, or palliation if they didn’t want to pursue heroic measures. We were in an economically depressed area and people spent a lot of time confronted with estimates they couldn’t realistically afford.

He was always kind and understanding and worked with them based on what they could do. It wasn’t, as he kept reassuring us, rocket science. Be kind. Laugh, for goodness sake, it’s not that bad.

He took the same approach with the terrified interns, who were performing under a great deal of pressure without a lot of knowledge under their belts. We’d come up to him, all of us including him up to our eyeballs in paperwork, for advice or a ‘can you take a peek’ or ‘HELP!’ and he always did, with nary an eyeroll or a sigh or a ‘in a few minutes.’ In a place where people routinely lost their sanity trying to stay afloat, I never saw the guy lose his cool, like, ever. He surrounded himself with a bubble of laughter impervious to the anxiety around him. It rubbed off.

I worked with him only briefly, but have heard news of him through my friends who remained and considered him a dear friend. I knew he had been battling illness for a while, and had dealt with it with his characteristic humor. He did well for a very long time and went on to charm many more clients in the years since we sat side by side in that chaotic treatment area, watching the world swirl by.

In Through the Looking Glass, Alice happens upon the Red King, napping beneath a tree.

“He’s dreaming now,” said Tweedledee: “and what do you think he’s dreaming about?”

Alice said, “Nobody can guess that.”

“Why, about you!” Tweedledee exclaimed, clapping his hands triumphantly. “And if he left off dreaming about you, where do you suppose you’d be?”

“Where I am now, of course,” said Alice.

“Not you!” Tweedledee retorted contemptuously. “You’d be nowhere.”

Dr. Naidus was very much this type of quiet force in many lives. I am sure he was greeted today by many pets he has helped over his long career, as they welcome him home. Perhaps he and Kevin are sharing a brew; it’s been a long journey. Life, what is it but a dream?


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Rest well, my friend. Thank you for being you.

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PS This is not the hospital I wrote about in this post. ;)

Filed: Blog, Cancer sucks, Daily Life, Featured Posts Tagged: ,

Do we need pet care advocates?

In the depth of my despair when Apollo was dying, the medical resident at the specialty hospital made a comment I will never forget.

He was dying of a blood clot, a sequelae of hyperthyroidism and heart disease. I was in shambles, having come home from the gym to find him immobile on the couch, and rushed in straightaway, sweaty and spandex-y. I scribbled his medical history as quickly as I could, which the resident pored over with her intern as I sat in the room planning to say goodbye. I knew at that point it was coming, I was just waiting for confirmation of the diagnosis.

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I had checked ‘yes’ to allergies, in the interest of being thorough.

“What allergies?” the resident asked.

“Food allergies,” I said. “Chicken.”

She paused, and shared a knowing glance with the intern. “And how do you know this?”

I blinked. “I’m sorry?”

“How do you know he has food allergies? Did you just assume, or did you actually test him?”

“I….I did an elimination diet, 10 weeks…not the full 12…. but it was obvious by that point,” I stammered, though what I really wanted to say is “WHAT THE HECK (ok maybe another word) DOES THAT HAVE TO DO WITH THE PROBLEM AT HAND?? WHO CARES HOW HE WAS DIAGNOSED WITH AN UNRELATED MANAGED CHRONIC CONDITION A DECADE AGO??”

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But you know, I just sat there because what are you going to do.

OK sure, let's talk more about Hills z/d and then can you please get this cat some morphine?

OK sure, let’s talk more about Hills z/d and then can you please get this cat some morphine?

Now, I understand that a teaching hospital is going to teach, but from the patient perspective I suppose I would appreciate the teaching being limited to the issue at hand instead of using an emergency cardiac event to make a point on dermatology. I don’t know if it was that, or the way she asked the question as if she were sure I was going to give the wrong answer, that rubbed me the wrong way. I also had to tell her not once but twice that I didn’t want to hospitalize him on the off chance his clot might dissolve enough to give us another month at home. We didn’t hit it off.

Fortunately I didn’t see her after that and was turned over to the lovely cardiologist who looked and talked like Oberyn Martell and understood when I said, “Please confirm my suspicion so I can give him a peaceful goodbye at home”, but it really reminded me, from the other side of the table, how hard it is to be a patient advocate for our pets. I knew what I was doing and I still had to push a little. It was a lonely experience.

It’s even worse in human medicine, as this ER physician who was hit by a car will attest to. Without someone who knows what’s going on to oversee the process and keep the focus on the overall wellbeing of the patient, things fall through the cracks. Flustered and underinformed family members get confused. Specialists focus on this problem or that problem and not the patient. How can we do better?

Um, no, actually.

Um, no, actually.

In human medicine, many hospitals now have designated patient advocates who serve as an invaluable liaison between a family and a healthcare provider. In veterinary medicine, it’s not something I’ve ever heard of, so we’re stuck with ourselves, the vet clinic, or the internet to help us make sense of complicated issues, to understand why the vet wants to do this or that and to empower clients to make informed decisions, including “No.” It’s not the ideal system, clearly.

I wonder if people would benefit from a neutral third party patient advocate group in veterinary medicine. I think things are only going to get more complicated from here on out, and as both a patient and a vet I think that sort of thing could only help. Food for thought.

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Have you ever felt confused and not sure how to proceed with your pet? Would it have been helpful to have a pet care advocate to serve as a liaison?

 

Filed: Blog, Daily Life, Euthanasia/Hospice, Featured Posts, Health, Musings Tagged: ,

Mañana

The look on the doctor’s face was more bemused than annoyed as he tried to explain what happened to the centrifuge we were supposed to be bringing to Nicaragua for the clinic. The valuable piece of medical equipment had been confiscated by a leery customs official the day before, and the shifty eyed official wouldn’t release it to us without running it by his boss. Who would be in tomorrow.

Mañana, the official said. Come back mañana.

So a local veterinarian, who understands the language and the local culture, was dispatched the following day to the airport to convince the customs officials that there was nothing untoward about a centrifuge and to please give it back to us. He met with a different and no more accommodating Nicaraguan official, who thought about it for a while before saying, No, you can’t have it.

Well, the vet asked, when can I have it?

Mañana, he said, come back mañana.  I never really got how this worked until this experience. The days stretching into the infinite, equipment locked up in an office to lord knows what end,  mañana becoming less of a day and more of a concept.Sometime, just not now, and maybe not ever. It’s not so much tomorrow, it’s the idea of tomorrow perhaps being more conducive to our goals.

Frustrating as the experience was for all involved, it’s not a foreign concept to any human. We are experts at procrastination, at remembering things a day after the deadline, of holding onto that bottle of champagne for a *really* special occasion that never materializes, of planning that special trip in our heads if not on our calendars and only committing to it after the chance has gone by.

Anyone who has lived with animals, seen a life arc before you in all too short a time, knows how this works. It doesn’t matter. We still continue to do this to ourselves:

We spend our childhood dreaming of things we can’t do, because we’re too young.

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Then we spend our adult lives dreaming of things we won’t do, because of work and kids and life. Mañana, we’ll do these grand things mañana.

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And at some point, they again become things we can’t do, because now we’re too old.

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(I know I wasn’t the only one cursing out Pixar through my ugly cry when Paradise Falls never materialized for Ellie.)

Somewhere in the middle, if we’re lucky, we can shake ourselves out of our certainty of tomorrow long enough to make mañana today. I’ve been doing this a lot more in the last few years, which I suppose is the natural progression of someone beyond the reckless optimism of youth and not quite ready to acknowledge that old is lurking right there in the wings.

It started with travel. It’s why I signed up for two weeks in Peru one year and another two weeks in Africa the next over the befuddled protests of my husband who wanted to know where I was going (somewhere interesting), with who (strangers that are now friends), and why (Why not?) Because at some point, I’ll know that I can’t.

It's never the wrong time to go somewhere new and make a new friend.

It’s never the wrong time to go somewhere new and make a new friend.

And while I can’t commit to globetrotting nearly as often as I’d like to, on a smaller scale I’ve decided to take on one mañana a year. Back in 2008, I attempted to train for a marathon and dutifully attended every group run, but my knees gave out at the 18 mile training run and I had to drop out. I can still do a half marathon, I told myself. Later this year, I said.

That was six years ago. A friend from the gym who is at the same point in her life asked me last week if I wanted to join a running club with her to train for a half marathon in August, which seemed like a good goal but maybe for later this year. I’ll think about it, I said, and later that afternoon read this story. If ever there is a sign from the universe to get off your butt and go do something, it’s a 91 year old cancer survivor running a marathon in your backyard while you lament feeling old at a little more than half a century younger.

So I signed up.

We never did get that centrifuge. I learned this in a dusty Central American airport back room: mañana never comes. Today’s it, so do that 5K or learn to make real macarons or take opera lessons or whatever it is you’re sitting on for later. What’s your mañana?

 

Filed: Blog, Daily Life, Featured Posts, Musings Tagged: , ,

Bosnia floods- when the world isn’t watching, donate a dollar

Massive floods in Bosnia and Serbia are the worst they have seen in 120 years. The world has been silent on this issue, in large part. In a place that is still struggling to recover from years of war, it’s hard to comprehend the magnitude of this disaster.

Understandably, the people in the affected regions have had little time or money to address the many thousands of animals affected by this disaster. Tens of thousands have died in landslides and floods, and thousands more are still in need of help.

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World Vets is on the ground, led by my friend and all around exemplary human Dr. Teri Weronko.

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In addition to the initial needs of rescue and shelter, stress can often lead to secondary problems such as pneumonia.

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When confronted with such nearly insurmountable odds and tragedy, there are two choices. One, close the computer, turn off the TV, and let it go.

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Two, put aside the sadness, get in, and do what you can. World Vets is a small group, but they have never shied away from going to the places that aren’t media- friendly enough to warrant the attention of larger organizations. It’s personal to me since I know the vet in the trenches, and here’s what she said:

I spoke to one old farmer who told me that from as far back as HIS father’s grandfather, no one could remember a flood of this size and destruction here…So many have lost everything. Your donation will not be lost in some big aid bureaucracy. People like me are here, at the farms, talking to the farmers and the veterinarians serving them. We come in in the evenings and call up World Vets with specific requests for needed medicines and supplies, and those items are purchased and loaded onto a pallet for shipment here. International aid donation doesn’t get more direct than this. Any contribution you can make, no matter how small, will help! -Dr Teri

I ask everyone to consider helping if you can; donate, spread the word about this silent disaster. One dollar means everything. To donate, click the link below: This fund is specifically earmarked for disaster response.

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Much of what Dr. Weronko has seen is too awful to publish, and she is there still scooping up puppies and doing what she can with a local team of veterinarians and animal professionals. Although I can’t be there, I will be making a donation later today so they know concern knows no boundaries. If you contribute, post below and let me know. I’m going to see what I have in my goodie bag and will send something along to a randomly selected person.

ETA: How about this? How about, I will select someone randomly to send something from my pawcurious goody bag to, and if you donate over $50 I will put you in the acknowledgements in my book? You know me, I’ll do whatever it takes here. (Make sure you let me know directly if you do this- I don’t have insider access to World Vets coffers ;)  )

Filed: Be The Change, Blog, Disaster Response, Featured Posts Tagged: , , ,

Glad to meet you

It is one of the sad ironies of being a veterinarian in clinical practice that most of your clients are majorly unhappy to see you. (Retrievers don’t count, they’re always happy to see you.)

The reasons are obvious: vet clinics mean temperature taking, and shots, and cold tables. Trust me, I don’t much enjoy heading off to my doctor’s office either, nice as the staff is. Those awful half length hospital gowns they give you (ladies, you know the ones I’m referring to)- cold and humiliating. I’m here for something I’m not going to like.

While we vets are working on it through incorporating Fear Free Practice ideas into practice- thanks Dr. Becker!- we still have a long ways to go. Which brings me to today.

One of the most common things I hear from clients at a home euthanasia appointment is, “I just couldn’t bear to do this at the clinic. My last dog was shaking like a leaf when we went in for the appointment and I felt so terribly guilty afterwards.” And who can blame them for feeling guilty? Who wants their last memory of their dog or cat to be them cowering in a corner? How awful.

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Not all pets feel this way about the vet, of course, but for those that do, it just adds another layer of emotional trauma to an already challenging time. Is this the pet signaling they don’t want to die? No. As pain management expert Dr. Robin Downing says, “Pets don’t fear death. They fear pain.” They are telling us they don’t like the vet, but of course we are only human and it’s hard not to extrapolate that to a bigger message that isn’t there.

So what happens in the absence of the clinic and the coat, when a pet meets me outside the office? A pleasant hello, usually. Even when I am there to help them transition. Especially when I am there to help them transition. I will be honest, I wasn’t expecting that.

I was reminded today of a lovely Golden I met last year, who was winding down a battle with cancer. When I came to the family home, their sweet girl was almost nonresponsive. As I knelt down by her side, she opened her beautiful brown eyes and gave me a huge, enthusiastic wag. We all stood there in shock, as she had not been able to do much of anything in the hours leading up to that moment. She did not fear death, or me.

In the absence of a preconceived assumption of vaccines and thermometers, pets are free to judge me based on whatever it is they perceive I am there to do. I cannot tell you the number of kisses, licks, wags, head bumps I get from pets who by all rights should be past caring who is sitting next to them. It means something.

It’s not, “Oh boy! THE DOCTOR IS HERE!”

It’s not, “That blond lady sure does smell good, like bacon.”

It’s simply this: I see you.

I know what a birdsong is.

And I am ready to hear it.

Filed: Blog, Cancer sucks, Daily Life, Featured Posts, Musings Tagged: , ,

One Twenty Over Eighty

A few years ago I ran away from my job.

At least, that’s what I called it at the time, that is how I framed it in my head. I couldn’t hack it, I was a failure as a vet. My mind was wrecked, my physical health was wrecked, and my stomach curled up into knots every time I pulled into the parking lot. It wasn’t only me who suffered; I knew my heart was not where it needed to be for my patients. They deserved for me to want to be there. It was a bad place to be in.

With the gift of perspective, I know now I was dealing with some pretty significant burnout. I didn’t know that was what it was at the time; after all, don’t you have to be in it at least a couple of decades for that to kick in? Or be a practice owner? This is how it works, I was told. No one really talked about it, or it was code for ‘bad vet’, not for a defined type of stress reaction. Old Doc Johnson who treats everything with pen G and steroids needs to get put out to pasture, he’s old and burned out.

No matter the reason, I knew I needed to leave and take a breather. I am very fortunate that my husband was supportive of the decision, even without knowing how it would play out, or when I would be back. Although I saw it as a failure on my part at the time it was the best thing that could have happened to me.

I have learned to let go of a lot of destructive ideas in the past few years:

  • that taking care of yourself is an indulgence;
  • that saying ‘no, I can’t’ means you are a slacker;
  • that being a veterinarian means you put your work above all other things.

I had to practice those sentences a couple years before I really truly believed them, but I do now. I listened to a wonderful VetGirl webinar today on the topic of veterinarians, depression and suicide and was kind of taken by surprise when our wonderful presenter said, “self care is an ethical obligation- to yourself and to your clients.” She’s right.

If you recall, one week ago today this happened in my neck of the woods:

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A few days after the smoke had cleared, I had a girls’ weekend getaway that we had been planning for almost half a year. Girls weekends aren’t really something I’ve done much of- too busy, other priorities- but we randomly decided at a Christmas party that we should plan one. I didn’t know how much I would be needing it at the time, but man, I’m so glad it happened the way it did.

I flew far, far away from my blackened streets and up to the land of one of the world’s finest philosophers: Santa Rosa, home of Charles Schulz.

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We ate, all weekend. Really, really good food.

2011-onetwenty-over-eight_webWe tasted some wine. Really, really good wine. Our personal favorite was a wine by Ehlers Estate, which was founded by a man with a deep philanthropic interest and is now owned by a trust that funnels all its profits into cardiovascular research. (I tell you this not to try and sell their wine, though if you ever get a chance you should absolutely try it, but because it ties into the rest of this story.)

The wine we sampled is called “One Twenty Over Eighty,” in honor of an ideal blood pressure. We liked it, so we bought a bottle to share that evening.

We all came on this journey with our own piles of stresses and stuff going on, and one of those things involved a friend taking a spot check blood pressure monitor, just to kind of keep an eye on things.

“I feel really relaxed,” she said later in the afternoon. “I’m going to check my blood pressure, just to see how it went today.”

She took it, looked at the numbers, shook her arm a little, and held up the monitor.

“One Twenty…Over Eighty.”  OK, maybe closer to 125/82, but nonetheless, it was pretty darn good. Magic, almost.

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On the last morning before we left, we bumped into Kenny G in a bistro. All I have for proof is a surreptitiously snapped picture of the back of his gloriously curled head, but it was confirmed that yes, we lunched with the G himself. Seriously, if ever you were waiting for a sign from the universe that you needed to kind of chill out for a few, there are few signs more blatant than running into the king of smooth jazz. This may top the time I ran into Weird Al at Disneyland (story for another time).

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Good friends, laughter that makes you snort in the most unfeminine of ways, and maybe a sip of an exceptional wine if that’s your thing. It may not replace all the medicines in life you might need, but a little self care now and then does wonders, it really does.

Here’s to your One Twenty Over Eighty, whatever that might be. Cheers.

Filed: Adventures, Blog, Daily Life, Featured Posts, Health, Musings Tagged: , , , ,
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