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Veterinary medicine

Age Is Not a Disease

Granted, sometimes it feels that way. When my left thumb joint aches from holding pots and pans while my right hand scrubs them. When the first few steps out of bed in the morning are on shuffling, surprisingly stiff feet. When I can’t avoid a glimpse of my sadly lax skin. However cliché it is to say it, though, my age is just a number. It is certainly not a diagnosis.

Medically speaking, age is part of what we call the patient’s signalment. It is a descriptive term. In people that means the patient’s age, sex and race. In veterinary medicine: age, sex, breed and species. We start with the signalment because right away that begins to narrow our focus. For instance, once you know you are dealing with a female, prostate cancer is off the table. No reason to even entertain the possibility. A Doberman isn’t going to have Feline Leukemia but probably has some degree of heart muscle disease. A 12-year old dog with vomiting and a palpable mass in his abdomen is more likely to have cancer while a puppy with those same symptoms and findings is more likely to have eaten a rock.

To illustrate: I will always remember a case in my early years of practice. I was called up to the lobby to triage an emergency because all of the examination rooms were already occupied. The owner was frantically cradling a cat all wrapped up in a towel. What seems to be the problem? All of a sudden he can’t move his back legs. OK, I said. Trauma it is. Let me take him to the treatment area. He was probably hit by a car. The owner protested. Absolutely not, he is 14 years old and never goes outside. Ok, then. Heart disease and a blood clot to his legs. A quick 180 degree turn and I was off and running again. That is why medical professionals are encouraged to obtain the signalment and medical history BEFORE making their diagnosis. Not my finest professional moment, but I think you see my point.

And getting back to that point, age is a starting place. It should not be the final conclusion. Yet I find people using age that way here in the islands. From other medical professionals asking me, “Do you really want to put an old dog through that?” (whether ‘that’ is surgery or a simple blood test) To owners debating, “Is it really worth doing – fill in the blank – at her age?” To the casual conversation with someone on the street discussing their sick pet and concluding with “Well, my wife says he’s just old.” (And here pets can be considered old at the ripe age of 7.) I honestly don’t remember this being the case in my previous practice life in the States. Of course, in all fairness that was 15 years ago. I am older myself now so it might be that (1) I am more sensitive to the inherent gravity (pun intended) of aging and/or (b) I am losing my memory. Nevertheless it bears repeating.

Age is not a disease.

Furthermore, age is absolutely not a death sentence. Contrary to popular opinion, nobody ever actually dies of old age. Something else happens. At the very least, their heart stops beating. Even dying of natural causes is the manner of death (as in not a homicide, for instance), but there still has to be a cause. Aging simply shifts the diagnostic focus. Again, it makes certain diseases less likely and makes others more likely; and, as ridiculously frustrating as it may be, as we age there are more diagnoses that don’t have ‘cures’ but only the hope of management and mitigation.

Let’s face it, as the years go by most everything gets harder…. scrubbing my pots and simply living another day included. But age is not, in and of itself, reason not to look or to treat or to try. One might find plenty of other such reasons, but age is not one of them. And as I am lucky enough to get older and older and hopefully older, I personally take comfort in that. Consider that I have been with Michael through lots of doctors’ visits and even two weeks of serious illness in a hospital in New York. Doctors recommended myriad numbers of tests, a few surgeries and prescribed beaucoup different medications, and never once did I take one of those physicians aside and not-so-subtly suggest, “yeah, well, but he is pretty old……..” I’m just saying.Birthday cake

 

Yes, Sir, That’s My Baby

This will be a quick one. We have been crazy busy and I am exhausted between installing crown moulding in hexagonal rooms where no two walls or angles are the same and practicing medicine. We have been running, running, running.

However, as a follow up to the goat C-section blog (http://whaddyadoallday.com/?p=722) I wanted to show you mom and baby at 3 days in the owner’s yard:Goat 3 days

And then at 2 weeks, here they are out and about strolling the  neighborhood as I took the photo from my car (the baby is not quite as brave out in the real world):goat 2 weeks

Speaking of cars, our Subaru needed a wee bit of body work. Not because of a crash or anything. Just because of the corrosive nature of living on the sea. Michael took it to a guy who works out of his yard. The place is absolutely jam packed with cars. When we returned to pick it up, imagine our surprise when parked there next to our current car was our previous (first) island car. Remember this post (http://whaddyadoallday.com/?p=722) and the one it references? Our Suzuki was dear to our hearts; and just recently, we were commenting on the fact that we hadn’t seen it on the streets in very long. But there she was in her new, tricked-out, purple glory. (No, I do not know the pink car.)

good old carSome comfort, though, I guess that if the guy who did the body work for us has kept the Suzuki from completely dissolving into oblivion, then he probably did a good job on the little rust spots on the Subaru.

Meanwhile, good to see both the four-legged and the four-wheeled babies doing well.

Of Goats and Men

So far our small, house call, veterinary practice here on the island has been only a bit different than we envisioned. We thought we would be busy doing primarily routine wellness exams, etc. In reality, however, we have been involved in a disproportionate number of complicated medical cases: unusual cancers, involved metabolic diseases, and major surgeries (performed in the local clinic or across the channel in St. Martin). It is all more of a logistical challenge given the limitations of our mobile, business model. But it is still the standard companion animal medicine we are familiar with so we’ve successfully worked things out on a case by case basis. The other night, though, the call came in that really tested our limits.

At 7PM the phone rang. It was hard for me to understand the caller, but it became apparent that he was calling because he had a goat that was having trouble delivering her kid. He tried to contact other people before us (I have no idea whom), and someone ( I have NO IDEA who) had suggested he contact Pelican Mobile PetCare. I tried to explain to him that I was a city vet. I have exactly ZERO experience with barnyard animals. So he put a woman on the phone to implore me to at least come to see if there was something I could do to help the poor animal. How do you say no to that?

Michael wasn’t home, but I managed to reach him and told him where to meet me by the side of the road….literally by the side of the road. After traipsing through the bush in the dark using my cell phone as a flashlight, we were led to the poor, pathetic, bleating, distressed goat. It turns out she had quite possibly been in labor for nearly 24 hours with the front feet of the kid visible since early that morning. After that many hours, that baby was not coming out in the normal and natural fashion in spite of our noble attempts to the contrary. The kid was likely already dead. (I could feel his teeth and he wasn’t trying to bite me.) And the mother would die too without intervention. She needed a caesarian section, but we are not equipped for that level of surgery. I have instruments and suture materials, but what I have is only really suitable for lacerations, biopsies, small lump removals, that sort of thing. Not sterile, major, abdominal surgery. We tried to explain this to the owner. Who would normally do this for him? Who would have done it two years ago when we were not available? It seemed that nobody else could help.

That’s how we found ourselves doing a goat c-section on a small table on the guy’s back porch under flashlights. We could have given a lecture on how NOT to do things. Local anesthetic only. Intestines spread out on disposable medical pads. Neighbors coming to watch and trying to video tape something that we most certainly did not want documented for posterity sake. It was a circus. When Michael finally pulled out the baby it sounded like a wine cork popping, but damn if he wasn’t still alive. And huge. The minute he was delivered it was impossible to imagine how he could have possibly ever been inside his mother in the first place. But that was only half of the process. We needed to get finished and close up. Unfortunately, the sutures we had were the equivalent of using 4-pound test fishing line to catch a marlin. We could only hope for the best. We rinsed everything with sterile fluids and bathed it all with intravenous antibiotics and put it all back into place. At one point, the mother became weak and barely responsive, so I instructed someone to mix some sugar and water and pour it into her mouth to treat likely hypoglycemia. Damn if she didn’t come around, too.

We tried to impress upon the owner that the mother and the baby needed to be strictly confined….a clearly foreign concept for a free range goat herder. We tried to set him up for the very real possibility that one or both of them would not survive the night. But at least they were alive when we left them. And they were alive the next morning when this picture was taken. (Seriously, I do not know farm animals, but doesn’t he look proportionally large compared to his full grown mother? Yes that is the porch were we performed the surgery, but at least mom was “confined” – i.e. tied to that little chair.)goat

We go to take mom’s stitches out today. We’ll see if someone is grateful enough to pay us something for our hard work and dedication or if this time saving lives has to be its own and only reward.

 

Just Don’t Call Me Late for Dinner

When I graduated from veterinary school I was Dr. Molek. At least on paper. But I never really went by Doctor. That was due to a combination of the laid back California lifestyle and Michael (whose clients always called him Mike). So I became just Georgia with a stethoscope. Not even Georgia with a white coat and a stethoscope. I never wore a white coat, either. Sometimes pearls, often times heels, but never a white coat. I’ll always remember running into a New England born and raised classmate of mine and ‘business attire’ came up in the conversation. She was so happy to be at a meeting where she could dress casually. And I said, ‘this is how I dress at work’. And she said, ‘not in jeans and stuff, right?’ Long story short she actually asked me, ‘how do your clients know to believe what you say if you aren’t wearing a white coat?’ And my response was, ‘I’d like to think they believe what I say because I make sense when I say it.’

Anyway, never really Dr. Molek. And all those years in California certainly never Dr. Paul. Michael was old fashioned enough to want me to change my name when we got married but didn’t want to confuse people by having two Drs. Paul practicing within 50 miles of each other. So I was, on paper, both Mrs. Paul and Dr. Molek. Even after we moved down here, my dual life continued so long as we rented our house during high season and traveled back to California where I’d return to veterinary medicine for a few months at a time. Mrs. Paul in Anguilla. Dr. Molek in California.

Now that I am finally working as a veterinarian in Anguilla, I have, at long last, completely morphed into one, single being. Remember, though, that this is an island that is fond of nicknames (SEE http://whaddyadoallday.com/?p=156) and unusual monikers though inexplicably the post office and the bank cannot or will not make the casual or legal connection between Mike Paul and Michael Paul being one and the same. Anyway it made me laugh when one of my very first clients asked me what she should call me. (Georgia, of course.) But apparently she and another client, a good friend of hers, had been debating the point and had settled on Mrs. Pelican (for Pelican Mobile PetCare). Worked for me.

Then the other day, in my professional capacity, I left a business card with an office receptionist so that she could call me back when she had the answer/document I had requested. Shortly thereafter my phone rang. The number was not entered into my caller ID but it quickly became clear that this particular individual was calling me back….as she started stuttering over how to address me on the phone with a hodgepodge of names and titles: Partially my fault since the business cards lists both my name and Michael’s name, and Georgia might register as George with a cursory glance. Then you can throw in the common confusion over whether Paul is the first name or the last name along with the added question in a Commonwealth country of whether or not a veterinarian is a Mr. or Ms. Or a Doctor. (By the way, a quick Wikipedia search reveals that just in March of this year the Royal College of Veterinary Surgeons in the UK finally voted to permit its members to use the title “Doctor”.)

We muddled through the phone call, and when I arrived to pick up the document I offered that I didn’t tend to stand on formality and that she should feel free to call me Georgia. I then suggested that since we would likely be crossing each other’s paths again in the future, it might be good for me to know her name. Her response? Miss Johnson.* Classic.

(Names have been changed to protect someone.)

To Life

In my last post I alluded to some 18 yards of upholstery fabric. That has now taken on a new life. And I’ll get you a photo but first let me run a different tangent.

Many, many, many, many, many years ago (OK, 30) I met Michael when I was a brand new, baby vet, just graduated and looking for my first job. He said that he couldn’t hire me but that I could live with him if I wanted; and the rest, as they say, is history. I didn’t want to seem like a total pushover, though. So after we packed up my things and drove all the way across country to California I did hold out for a total of 10 days sleeping on a college friend’s couch before moving into Michael’s apartment. So I wasn’t actually living with him when I went off to my first day as a bona fide medical professional. That morning, when I walked out to my car I found a note on the windshield. It said, “Happy First Day Saving Lives”. (Awwww.)

Now, I am going to share a closely guarded professional secret with you. Promise you won’t tell. When I was a student in veterinary school, someone told us that medicine is a pretty good odds racket. Animals tend to get better…..and get this….in spite of us. The statistic that was quoted was somewhere in the range of 80-85% of our patients get better even if we do the wrong thing. That’s just the way Mother Nature works. On the other hand, sadly somewhere around 5% will not – even if I am the brilliant veterinary equivalent of Linus Pauling or Michael DeBakey.

That means that I truly make a difference in only about 10-15% of the cases I see. All cynicism aside, the take home message here was not to comfort us in the knowledge that we could just rest on our laurels and count on the odds to get us through but rather that because we could not know which of the cases were which that we had to give every single one of them our very best in order to guarantee that we were taking every opportunity and making every effort to impact the ones that we could. And I have never forgotten that advice not even after these long 30 intervening years. Do I always do everything absolutely right? Not likely. But I sure as hell do try.

And it hasn’t surprised me at all that people out here on this little rock will go to the lengths that they will in order to provide health and well-being for their pets. It surprised me more when the one person told me that I needed to remember where I was practicing. I corrected him immediately. My job, the only way I know how to do it, is to tell my clients what I understand and believe to be the very best course of action to take for their pets’ problems. IF that is not an option, THEN my job is to work with them to find an option that is suitable and to support them in their decisions. But my job is not to offer less from the start.

Might this particular dog or that particular cat get better with a different approach? You betcha. In fact it probably will. I already told you that. But if it doesn’t, if it’s one of the ones that doesn’t, and I haven’t offered my best, then I’m the one that has to live with that. That’s why I end up researching everything from new anti-seborrheal products to cancer treatments, having CTScans run, and battling to bring horribly uncontrolled, hyperthyroid cats back from the edge of the abyss. And that’s why a couple of weeks ago I found myself on a client’s back porch resuscitating an incredibly weak, one pound kitten. The poor little thing desperately wanted to eat but could hardly lift her head. She passed out and her heart stopped beating at least three times. Was she in the 80% or the 15%? I’ll never know. But I do know she wasn’t in the 5% because I vaccinated her on Saturday.

Thanks to her family for literally nursing her back to life. Her name is Ashes but as is the way here in Anguilla, I gave her a nickname. To me she will always be the Phoenix. And I am glad that I could be there with/for her. Because of all of the things “thatIdoallday”, it really is nice to be able to practice medicine again.

So as promised here are the new slipcovers. (all the green and the bar stools are the new bits.) Aren’t they pretty?

slipcovers

But here’s little Ashes, the Phoenix. She’s pretty darn cute, too.

Phoenix

Happy Gazillionth Day Saving Lives.