Wednesday, February 09, 2005

Viva la difference

Most of the time I commute from the northern suburbs of Austin way down to the south (some say hipper) side. It takes about 1 hour to drive to this clinic. However, it is worth it to me, since the clinic is the best that I have ever worked in, and I only commute part-time. The medicine is top-notch, the support staff is well trained, and the clientele is in love with their pets and affluent enough to pay for excellent care.

About once a month I work in a clinic in Round Rock (far North suburb) that is also good, but very different. It is a one-doctor clinic (the south clinic is 4 doctors), and usually I work to give the owner a break, or let him go to Dallas for a doctor's appointment. I still work there on occasion because I feel some loyalty -- it was one of the first places I worked when I first started doing relief work (temping) after my daughter was born, and they still invite me back. Also, it is about 10 minutes from my house, so I get home well in time for dinner, and can even see my kids on my lunch break. The staff he has working there are very fun and they do a good job, as much as they are allowed. And, I can earn a little extra money.

But, being a one-doctor practice makes for a different practice culture.

For one thing, since he's always there, he tends to do all the technical stuff. The staff can draw blood, but he puts almost all of the IV catheters in. He's a little cheaper when it comes to expenses. And, he helps take ALL the Xrays.

I like to interpret Xrays. I hate taking them.

At my regular clinic, we have trained staff that can take better films than me anyway. And there's enough of them for me to give them an Xray request, and go on to do other work.

At the Round Rock clinic today, we had a 95-lb mastiff, 1 year old, who was a chronic vomiter/regurgitator, whose vomiting had gotten worse over the last week, was not eating, and was losing weight. I wanted to rule out megaesophagus and foreign body obstruction, and that meant Xrays.

I put on the lead apron, which at this clinic is the most UNCOMFORTABLE I've ever tried. Instead of having wide shoulder straps to support the weight of the apron, these have a knotted strap. After about 30 seconds that knot is boring into your lower neck. Then, there is the technique chart that makes NO SENSE. So, I make my best guess at the settings. The staff never take the Xrays, so they have no clue how to help me. And there is only one cassette.

Because Xray pictures are a 2-dimensional view of a 3-dimensional animal, you almost ALWAYS have to take 2 views, so most clinics have 2 preloaded cassettes of film. At this clinic, you take one view, wait for the tech to change out the film, then take another view.

I wanted 3 shots, actually (lateral chest, lateral abdomen, and ventral dorsal abdomen). So, the tech put the phones on hold (the other girl was at lunch), we lifted the beast onto the table, took one view, she changed the film, took a second view, she changed the film, then tried to take the abdomen shot, with the dog laying prone on his back. It was a struggle to convince this large deep-chested young dog to lay still on his side for the first 2 films, and IMPOSSIBLE to get him to lay on his back, so we punted and shot it with him "squatting" on his abdomen.

The first set of films were all too light. So, I adjusted the technique and we reshot. OK, but I was still unsure of the esophagus, and the DV abdomen was still too light, so we reshot it, gave him a little barium, and reshot the lateral chest. Then I gave him a little barium in food, to be sure, and reshot it again.

So that's 9 films, with an uncooperative dog, with an uncomfortable apron. It took well over an hour.

The good news for the dog is he definitely doesn't have mesaesophagus, and I couldn't see an obstruction (so no surgery needed). I decided he had gastroenteritis (or possibly IBD) and treated him medically (reglan, bland diet, etc). The bad news is, the husband owner was VERY CONDESCENDING to his wife, telling her "Why do you even open your mouth when you are just going to lie to the vet? Why don't you just go wait outside," when answering the question, how often does he vomit? That sweet dog has to go home with those people.

Sure was great to go home to my precious demanding children and wonderful husband 10 minutes after quitting time.

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