The past several months have been full of changes, both emotional and physical, and I and my family have been making lists of what we want to do and try. Some are things to make us healthy, and some are things to make us happy. Here are mine:
Foods to try:
Fiddleheads, bitter melon, kohlrabi, rutabega, custard apple, gooseberries, dragon fruit, figs, guava, soursop
Exercises: chin up/pull up, dead lifts, surfing, rock climbing, rope climbing
Places to visit: Spain (again), Greece, Paris (with my daughter), Japan - including much of the countryside, Hawaii, The Sea of Cortez, Egypt, New Zealand, Ireland, Iceland, Vancouver BC, NYC (again), Jamaica, Belize (again), Chile, Scotland (again), Italy, the Galapagos Islands, Switzerland
Cuisines to explore and really understand: Korean, Northern Italian, Creole, Egyptian, Greek
Languages to become fluent in: Spanish - both Mexican and Castilian, French
Languages to partially understand: Japanese, Korean, Italian
Personal goals: conquer my trichotillomania, get stronger than I ever was in my life, regain full function of my right leg (linger nerve issues from a back problem), pass my specialty boards in 2+ years, get a job where I never work overnights again when the residency is done, be able to travel 4 times a year.
Hair colors to try: blue-black, light orange, magenta, ombre-style fading from brown to purple
Home/life changes: no more processed foods at all, help the kids become teenagers with grace, reduce my spouse's stress levels, get all our debts paid off - including the student loans in 15 years.
What about you? What are your goals?
Thursday, May 3, 2012
Monday, April 23, 2012
Feed raw
I work in a big city with its share of people who subscribe to alternate ways of feeding their pets. I have met clients who swear that only organic is the proper way to feed their dog, or that their cats must eat a canned grain free diet. Others will only feed a home-cooked meal to their pet, or insist that Fluffy needs numerous extra vitamins and supplements even though he is being fed a well-balanced commercially prepared diet. My biggest challenge though, is how to respond to people who insist on feeding raw.
I have a secret. I have fed raw to my dogs in the past. They did okay on it - no diarrhea, but no miraculous improvement in health. I stopped feeding it because I had kids, and was getting uncomfortable with the safely aspects of raw meat around babies and toddlers.
Feeding a raw diet safely can be incredibly difficult to do. First of all, keeping the home sanitary is challenging. Bacteria naturally likes to grown of raw foods, even those which have previously been frozen or sterilized. Microscopic particles of food may end up on the floor next to the food dish, promoting bacterial growth. Most people, I'd hope, would wash the food dished with hot soapy water, but how many people would clean the floor under the dishes if it appeared clean?
Second, even commercially prepared raw food can be contaminated. Most commercial preparers work hard to provide a safe product, but there have been issues in the past with contamination. Salmonella is a bacterial infection which causes intense vomiting and diarrhea, usually resulting in hospitalization for the ill pet. Raw diets that are mixed together at home from meats purchased from a grocery store may be at a greater risk of contamination because the majority of meats destined for human consumption are expected to be cooked. I don't know if this means there are increased numbers of coliform bacteria on the ground meat purchased in the meat aisle, but anyone can search the CDC database for information on how often meat is recalled due to contamination.
Third, some people have no clue how to feed a raw diet, and just throw down some ground beef, thinking it's fine. They pay no attention to the fact that these animals need vitamins and minerals which either need to be provided through vegetables or supplements. In turn, their pets become ill from problems such as low taurine (causing heart disease in cats), low calcium (causing weak muscles and bones in dogs and cats), and low vitamin B (which causes general malaise).
Finally, some people choosing to feed a raw diet feed raw meaty bones rather than ground up bone chips. As a veterinarian, I have seen a dog with an esophageal obstruction from a raw turkey neck, another dog with a perforated stomach from splintered chicken bones, and several dogs with intestinal obstruction from bones.
I don't like raw diets because I unfortunately see the problems associated with it. It's also annoying to have to double glove or wear other protective gear when handing a dog or cat which is fed a raw diet because I don't want to catch salmonella. And truthfully, some of the clients who feed a raw diet are either pushy or defensive about their feeding choices, which can make it very tiresome to question them about other husbandry issues with their pet.
However, there are times where I see a healthy dog with clean teeth whose owner feeds an appropriate raw diet in a safe manner. Those are the people and pets which are a joy to work with. Raw may be a fad, or may be a way of feeding here to stay, but if you're going to do it, please consult with a veterinary nutritionist to make sure you're doing it right.
I have a secret. I have fed raw to my dogs in the past. They did okay on it - no diarrhea, but no miraculous improvement in health. I stopped feeding it because I had kids, and was getting uncomfortable with the safely aspects of raw meat around babies and toddlers.
Feeding a raw diet safely can be incredibly difficult to do. First of all, keeping the home sanitary is challenging. Bacteria naturally likes to grown of raw foods, even those which have previously been frozen or sterilized. Microscopic particles of food may end up on the floor next to the food dish, promoting bacterial growth. Most people, I'd hope, would wash the food dished with hot soapy water, but how many people would clean the floor under the dishes if it appeared clean?
Second, even commercially prepared raw food can be contaminated. Most commercial preparers work hard to provide a safe product, but there have been issues in the past with contamination. Salmonella is a bacterial infection which causes intense vomiting and diarrhea, usually resulting in hospitalization for the ill pet. Raw diets that are mixed together at home from meats purchased from a grocery store may be at a greater risk of contamination because the majority of meats destined for human consumption are expected to be cooked. I don't know if this means there are increased numbers of coliform bacteria on the ground meat purchased in the meat aisle, but anyone can search the CDC database for information on how often meat is recalled due to contamination.
Third, some people have no clue how to feed a raw diet, and just throw down some ground beef, thinking it's fine. They pay no attention to the fact that these animals need vitamins and minerals which either need to be provided through vegetables or supplements. In turn, their pets become ill from problems such as low taurine (causing heart disease in cats), low calcium (causing weak muscles and bones in dogs and cats), and low vitamin B (which causes general malaise).
Finally, some people choosing to feed a raw diet feed raw meaty bones rather than ground up bone chips. As a veterinarian, I have seen a dog with an esophageal obstruction from a raw turkey neck, another dog with a perforated stomach from splintered chicken bones, and several dogs with intestinal obstruction from bones.
I don't like raw diets because I unfortunately see the problems associated with it. It's also annoying to have to double glove or wear other protective gear when handing a dog or cat which is fed a raw diet because I don't want to catch salmonella. And truthfully, some of the clients who feed a raw diet are either pushy or defensive about their feeding choices, which can make it very tiresome to question them about other husbandry issues with their pet.
However, there are times where I see a healthy dog with clean teeth whose owner feeds an appropriate raw diet in a safe manner. Those are the people and pets which are a joy to work with. Raw may be a fad, or may be a way of feeding here to stay, but if you're going to do it, please consult with a veterinary nutritionist to make sure you're doing it right.
Wednesday, April 18, 2012
Hip Hip HIPAA
In veterinary medicine, we do not have any national regulations similar to those seen in human medicine. Which means that HIPAA does not apply to us veterinarians and our interactions with clients and patients. So really, if I wanted to, I could write whatever I wanted to about any of the animals I've seen, include identifying characteristics, describe the clients, name names, etc.
But I don't, because it's just stupid to do so. And it's completely unethical.
As a veterinarian, I have sworn not only to protect public health, promote research, and conserve animal resources, but I have also sworn to relieve and prevent suffering. Most importantly, I have sworn to do so, following the ethics of veterinary medicine. To me, this include the rights of the clients to privacy.
So I may write about some amazing cases, describe details, even give names of animals. But it's not real. Every animal I write about, every client I describe, has either given me permission to do so, or more likely is a conglomeration of several other cases I've seen. It's challenging, because I see some doozy clients and some amazing cases, and I have to really think how I change things to still illustrate the case without breaking privacy.
Most veterinary hospitals now a days have privacy guidelines for their employees. These are designed to make sure someone doesn't share a photo of a horrifying injury to a dog's chest on Facebook, or blog about the celebrity who brought their cat in for difficulty breathing, or tell all their neighbors about how many birds are owned by someone living on the next block.
Just because we don't have government regulations keeping us honest, doesn't mean that you can't trust your veterinarian to honor your right to privacy. Okay, if you're in a restaurant, sitting next to a table of veterinarians, you may overhear more than you'd ever want to know about treatment for bloat, or how maggots sound when they're under the skin, or how much we all seem to love lancing abscesses. I can promise, that at least among my friends and colleagues, if I need to discuss a distinct case, it will be either in person at the office, or over the phone where I know we won't be overheard.
To let you know how uptight I am about this, let me set you an example. My husband often asks how my day was when I get home. Initially, if I'd had a really difficult case, or a really cute patient, I'd start to tell a little, but then would stop. He's ask for details, confused why I would suddenly clam up, but quickly learned that I had reasons for not breaking privacy. So now, when I come home, he's used to hearing me say one of the following: "too much death," "really juicy cases," "I wanted to eat my patient on a cracker," or "where's the wine." That last phrase is the most common.
But I don't, because it's just stupid to do so. And it's completely unethical.
As a veterinarian, I have sworn not only to protect public health, promote research, and conserve animal resources, but I have also sworn to relieve and prevent suffering. Most importantly, I have sworn to do so, following the ethics of veterinary medicine. To me, this include the rights of the clients to privacy.
So I may write about some amazing cases, describe details, even give names of animals. But it's not real. Every animal I write about, every client I describe, has either given me permission to do so, or more likely is a conglomeration of several other cases I've seen. It's challenging, because I see some doozy clients and some amazing cases, and I have to really think how I change things to still illustrate the case without breaking privacy.
Most veterinary hospitals now a days have privacy guidelines for their employees. These are designed to make sure someone doesn't share a photo of a horrifying injury to a dog's chest on Facebook, or blog about the celebrity who brought their cat in for difficulty breathing, or tell all their neighbors about how many birds are owned by someone living on the next block.
Just because we don't have government regulations keeping us honest, doesn't mean that you can't trust your veterinarian to honor your right to privacy. Okay, if you're in a restaurant, sitting next to a table of veterinarians, you may overhear more than you'd ever want to know about treatment for bloat, or how maggots sound when they're under the skin, or how much we all seem to love lancing abscesses. I can promise, that at least among my friends and colleagues, if I need to discuss a distinct case, it will be either in person at the office, or over the phone where I know we won't be overheard.
To let you know how uptight I am about this, let me set you an example. My husband often asks how my day was when I get home. Initially, if I'd had a really difficult case, or a really cute patient, I'd start to tell a little, but then would stop. He's ask for details, confused why I would suddenly clam up, but quickly learned that I had reasons for not breaking privacy. So now, when I come home, he's used to hearing me say one of the following: "too much death," "really juicy cases," "I wanted to eat my patient on a cracker," or "where's the wine." That last phrase is the most common.
Tuesday, April 17, 2012
Formulas
In a residency, the residents are expected to learn everything. In my residency, everything includes journal articles published in 8 different veterinary journals, the entire contents of at least 10 books, and every nugget of wisdom which can be wrung from my mentors' brains.
Now remember, this amount of reading and memorizing is done in conjunction with an average of 50 to 60 to 70 to 80 hours of work a week, often performed overnight.
Yes, I am behind, way behind, my self-imposed schedule for reading. So today, I am going through every book I have, copying down all the individual formulas I'll need to memorize in order to pass my board exam in 2 years and 5 months.
Excuse me while I go vomit.
Now remember, this amount of reading and memorizing is done in conjunction with an average of 50 to 60 to 70 to 80 hours of work a week, often performed overnight.
Yes, I am behind, way behind, my self-imposed schedule for reading. So today, I am going through every book I have, copying down all the individual formulas I'll need to memorize in order to pass my board exam in 2 years and 5 months.
Excuse me while I go vomit.
Monday, April 16, 2012
Old is new
We have a new old dog, a dapper gentleman named Kerby who is the most laid back basenji I have ever met. We got him through the basenji rescue organization, and are thrilled that he is in our lives. Right now, he's sleeping by me feet, in a patch of sunlight. Later, we'll go on a gentle walk around our neighborhood, and see if he can find a squirrel or two to chase.
I have had clients ask me when their dog has died, if I'd recommend they get a new dog right away. Every person is different - some need time to grieve over the loss of their companion, while others feel incomplete with a dog in their home. We waited one year after our last dog died, and I personally was ready to get a dog within 6 months. I would recommend to anyone who is uncertain about handling the exuberance of a younger dog to consider adopting an older dog. Kerby is 9, nearly 10 years old, and I will be grateful if we get 3 to 5 years with him. He is perfect for our family right now - I can't imagine someone in a residency handling a puppy's needs well.
I'll likely include more photos of Kerby in future posts, so everyone can fall in love with him.
Friday, March 23, 2012
Herbal lore
The characters: me, cute French bulldog puppy named Gomer, Gomer's owner - Mr. SoCal, and Scary Vet Tech
Me: So tell me why you're bringing Gomer in at 3 am.
Mr. SoCal: Man, I was sitting on my roof with Gomer when I saw him trip and fall. I head that dogs that fall when up high can get totally fucked up.
Me: Wait, are you saying that your dog fell off the roof?
I look down at Gomer, who is prancing around, snuffling and begging for attention. He looks FINE.
Mr. SoCal: No man, he fell onto the roof. You mean him being up high didn't hurt him?
Scary Vet Tech (in an aside to me): No but you being high will hurt him.
Me (in an incredible display of self-control): No sir, but I wouldn't recommend you take him up on the roof again.
Me: So tell me why you're bringing Gomer in at 3 am.
Mr. SoCal: Man, I was sitting on my roof with Gomer when I saw him trip and fall. I head that dogs that fall when up high can get totally fucked up.
Me: Wait, are you saying that your dog fell off the roof?
I look down at Gomer, who is prancing around, snuffling and begging for attention. He looks FINE.
Mr. SoCal: No man, he fell onto the roof. You mean him being up high didn't hurt him?
Scary Vet Tech (in an aside to me): No but you being high will hurt him.
Me (in an incredible display of self-control): No sir, but I wouldn't recommend you take him up on the roof again.
Thursday, March 22, 2012
Toxicity
As someone in the field of emergency and critical care medicine, I see a ton of toxins. Literally, I will have on average 3 to 7 patients presenting for a possible toxic exposure each week. One of my colleagues, who trained in emergency medicine, realized that there is a vast amount of knowledge to spread to pet owners about toxins. He became so dedicated to this idea, that he started a business called the Preventive Vet. If you live in the Pacific Northwest, you should contact him. If you live elsewhere, you should read his website.
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