Good as New

After a yucky week at work (long days, more favorite patients lost), we had another busy full weekend. The kids enjoyed a drop-off Halloween party, and the adults enjoyed a wedding party (with much dancing). Anna and Colin both got hugely scraped elbows from falling while scootering. I went on a long, lovely bike ride - I do so love that bike Anthony got for my birthday, it feels like I'm flying, especially on a breezy sunny day - and came back to find that Anna had fallen on the sidewalk again. When she asked her dad to check if her lip was bleeding, he spotted her chipped tooth and said, "OH MY GAWD!" That reaction completely freaked her out and she spend hours agonizing over her broken permanent tooth. It looked like this:



Quite a horrible break, but fortunately not into the pulp of the tooth, which would have been FAR FAR worse. I called our pediatric dentist, and he was able to fix it today with a composite. I have a composite on one of my front incisors where there is a divot in the enamel. What I didn't realize was that because hers went into the dentin and was more sensitive, she was going to get a shot of local anesthetic. Several shots. We did it without the nitrous, and Anna was a brave soldier. 30 minutes later, she looked like this:

This was taken with my phone, so there's not much detail, but he really did a beautiful job! Anna was so pleased and so relieved, she was giddy. And although she had a fat-feeling lip, she was happy to go to ballet afterwards. Such a trooper!

Harvest

We had a great weekend, thanks in large part to the weather. It was sunny, breezy, lows in the 50s and highs in the low 70s. Summer is long and arduous in Texas, which makes us appreciate fall so much. Anna was remarking on how spring is nice, too, but then you know its just going to get hotter...

So for now, cool crisp fall is upon us, and we celebrated by ending our summer garden. Saturday night I made grilled chicken breasts, marinated in basil, rosemary, and lemon (from a meyer lemon that fell off early). We also had a mixed pepper salad. The kids found one overgrown huge eggplant. We have a wonderful heirloom called Rosa Bianca. It makes grapefruit sized white fruit with streaks of lavender. They are never bitter, always creamy and nutty, but I was worried about this overgrown one. I chopped it up and cooked it in olive oil, garlic, onion, tomato, and basil. Normally I am the only one to eat the eggplants, but Anna spied that stew and said, "That looks delicious!" It was one of the best eggplants this year. She and I devoured it all.

Sunday, we were all in the garden, pulling out the old tomatoes and 2/3 of the basil - with the rain its gone crazy, with huge, dimpled leaves. However, its choking out the thyme and oregano, and we need room for the fall plants. I picked only the most perfect leaves from the bushes that we culled... and ended up with 2 large bowls of leaves. Hard to believe there is still a ton left in the ground. At least now the broccoli, cabbage, and lettuces can finally take root.

Of course I had to make a massive batch of pesto with all that basil, which Anthony and I slurped down after the kids went to bed. Ah, the true end of summer 2009... can't say I'm sad to see you go, especially with all that pesto in my freezer. Still, sad to think I won't have another sublime tomato or eggplant until next hell season.

Won the battle, lost the war

Where did this week go? Crammed full, as usual. Long days at work, lots to do at home. Wednesday I did have some fun, going to Ikea and out to lunch with a girlfriend. It was a nice respite before gymnastics/piano/dinner/homework/bedtime/work again.

I have an old patient who I've been treating for a year now with Cushing's disease (hyperadrenocorticism). This is a super-complicated disease. The patient has to take just enough medication to kill off just enough adrenal gland to make them have normal cortisol production. Not enough, and they are out of control. Too much, and you can destroy the entire adrenal gland and end up with Addison's disease (hypoadrenocorticism) - the opposite disease.

My patient, a sweet geriatric dachsund, was extraordinarily hard to regulate. The test to check the adrenal gland function is expensive ($130) and requires two blood draws over a few hours. I would tweek her medication, then retest in 4 weeks. Tweek again, and retest in 4 weeks. And so on, for nearly a year.

The owner was a dream. She never complained about the frequent visits or the costs. She called me with every slight change in symptoms. Her goal was always to make her pet's life as good as possible.

This week she came in for her adrenal test, but now she had not been eating for nearly 3 days, and had vomited. Was her adrenal gland over suppressed? My patient seemed so depressed. I ordered a full blood panel (another $100) in addition to her usual test.

Amazingly, for the first time her adrenal gland function was normal. I'd hit upon the right combination of drug for her. Unfortunately, her kidneys were in failure. We put her on fluids for 24 hours, but saw minimal improvement. An ultrasound revealed end stage kidneys -- little hope for recovering any function. By now, she hadn't eaten in 5 days.

Her dedicated owners decided to stop treatment and end her suffering. It was a decision I supported. They came in red-faced and sad for her euthanasia. I was crushed, too. After a year of frequent treatment, the staff and I were quite fond of her. I was frustrated that I'd finally got Cushing's disease under control, only to by side-swiped by kidney disease.

The patient was quiet, sweet, and ready to go. The owners said goodbye, and I did, too. As I bent down to her, she licked me on the nose - always before she had been reserved, but I think this time she could see how sad I was, and she was actually trying to comfort me. For the first time, she reached out to me. Her breath was stinky from uremia and dental disease, but those kisses were so sweet and precious.

Cruelty Free Bacon Now at Sprouts

Some of you may remember that I avoid conventionally raise pork products. I cannot support raising pigs, animals with the intelligence on par with a dog or 3 year old child, in farrowing crates that don't let the mothers move around. All they can do is stand or lay down; they cannot even turn around. (Having recently been a mother cooped up with a new born, I know that you need your own space!) Also, adults are raised on concrete and therefore cannot wallow in the dirt like their instincts tell them to. So, I've been buying my pork at the farmers' market from Peach Creek Farms. Love their ground pork, chops, and stew meat, but not so much their bacon.

Happily, Pederson's Natural Farms Bacon is Certified Humane by the Humane Farm Animal Care Program. (Its nitrate free, too. And from Hamilton, Texas. That's local to me.) I can buy it at Sprouts, and their eggs are humanely raised, too. Our hens are old and the days are getting shorter, and we're getting about one egg per week. After caring for chickens, I don't want to ever buy eggs from places that put 1000 chickens in a space the size of your guest bathroom, stacked in crates, crammed in on top of each other. My eggs and bacon come from the farmers' market or Sprouts.

Now Anthony wants to know why I don't apply these rules universally to beef, lamb, and poultry raised for meat. Well, a girl has to have her priorities. I prefer grass-fed beef, but its not always practical. I do buy it intermittently from the farmers' market. Also, we eat a lot of Morningstar Farms meat substitute products instead of beef (ie taco meat, chili meat, burgers, etc). We don't buy a lot of lamb, and about half the time I buy it grass fed at the market from Loncito's. Free range chicken and turkey is not very available either, and unheard of at restaurants. And chickens raised for meat don't live (suffer) as long as egg-laying hens.

Many feel we Americans should be eating less meat anyway, certainly not three times a day. We frequently go meatless for dinner at our house: tofu, tacos, pasta, egg-based dinners, etc.

Also, these animals (cattle, lamb, and poultry) are not on the same intelligence level as pigs. I feel that the pigs do suffer more. So I am happy to bring home the bacon, fry it up in a pan!

Change of heart

I got a request to refill a medication on a dog we haven't seen for two years. Legally, they must be seen within the last year to fulfill to maintain the doctor-patient-client relationship, so I refused. The dog showed up in the afternoon for an appointment, also overdue for vaccines and heartworm testing.

The dog was nice enough, although nervous and unruly. "She drives me crazy," the owner said. "She can't be around other dogs, so I can't take her on walks, because what if she sees another dog? And she goes nuts when my parents' dogs come to visit. So she doesn't go anywhere but the house and the backyard." I mentioned the dog was overweight, and she said, "Well, that's because she doesn't get any exercise. But I can't take her anywhere. She drives me crazy. And look at this shedding." I tried to let all the complaints about her dog roll of my back. She even complained about fitting the cost of the appointment into her budget. At least she wasn't complaining about having to make the appointment.

At the end of my exam, I said, "Unfortunately, her heartworm test came up positive." "What?" the owner said, "I can't believe it!" She got very quiet. I talked about the process for treating the worms, starting with chest Xrays and labtests, ending with a series of intramuscular injections. It is expensive, especially for such a big dog. "I'm so stunned," she said. Well, we weren't; her dog had been off preventative for over a year. We don't prescribe it just for fun in Texas. Even at my high-compliance practice, we treat about one dog per week. I offered to get started today, or we could schedule in the future if she couldn't afford to start now. "No, I'll have to reschedule. But I'll definitely save up. I don't want her to die! I just can't believe this."

Funny how she changed her tune, but I'm glad to know she really does care about her dog.

All knowing

So work for me was DEAD on Tuesday. Again, denied the moderation that I crave!

We had parent-teacher conferences this week. We found out Colin is reading above grade level (a pleasant surprise) and that he is doing well with his coursework but having a hard time keeping his hands to himself (not a surprise).

Anna's conference was very enlightening. She came along -- I was worried about this, but she insisted, and it ended up being a great parent-teacher-student meeting. Anthony was there, too, via speaker phone. After the usual "she's so great, and nice, and responsible, and smiles all the time," we cleared up some misunderstandings about problems that were marked wrong when we thought they were right (they were actually corrected after grading). We also discussed how Anna needs to pick more challenging books, and her teacher agreed and explained to both of us what books she needs to pick and how she can move up on AR. Lastly, her teacher also told us that although she gets all her work done in time, she is drawing and coloring during most of the lesson and work time. If she would get her work done first, she could work on fun, challenging projects the REST OF THE WEEK but instead is frittering her time away. I understand that she is both bored and very creative, so it was so helpful to have this discussed all together. Now we all know she needs to get 3rd grade work done first, then move on.

We have the pleasure of my Chilean friend Fran's company again this week. She is studying to take the US veterinary exams, and while she was taking an online review of equine diseases I premade an enchilada casserole to eat after gymnastics and piano lessons. When I pulled it complete out of the oven, she said in surprise, "When did you make that?"

Anna sighed, and knowingly said, "Fran, you miss a lot, don't you?"

As they say in Chile, "Ja ja ja ja ja!"

Troppo

Things at my clinic were dreadfully slow in July and August. Summer is usually our busy season; blame the recession. It picked up in September, but like this: crazy gulping down your lunch busy one day, twiddling your thumbs dead the next. Personally, I prefer moderation in all things. Or better yet, a busy morning, then coasting through an easy afternoon until quitting time.

Last week for me was busy morning and afternoon. I had big dental procedures in the morning. Tuesday night brought a cat with major head trauma from being hit by a car 20 minutes before "closing." We stayed late (of course) to stabilize her and send her to the emergency clinic. Later I found out she died there at 3 am. Thursday ended with a euthanasia, a poor cat with an ear tumor so painful all she could do was lay on her side and howl. I felt so bad for her, I gave her a morphine shot before I euthanized her. That totally backfired on me, since it made her vomit violently right before I dispatched her. Not what I had in mind for her last moments.

Friday was the worst, though. The day ended with me going to do a home euthanasia. One of my friends, a former technician at my work, asked me to help her friend. Thank goodness she came along to help me. With the unexpected traffic it took 45 minutes to get to the house. I met the owner and the dog, emaciated with liver cancer but sweet and friendly. I could tell within moments of meeting them that she was as attatched to her dog as I was to mine, and feeling as much turmoil as I did when I had to euthanize Terlingua and Montana. We discussed her reservations, then they went outside for a walk and to say goodbye. You just can't rush these things - its her last moment with her dog. Finally the deed was done, smoothly and peacefully and tragically, then we loaded the dog up and made the long journey back to the clinic. We arrived way past closing, and I still had to make a clay pawprint (to give the owner later), put him in "the morgue," log the drugs, call back the owners who picked up patients while I was gone...

I got home hours late, much to the consternation of my children. And then had to work on Saturday and stay late, to help out a client who works on Saturdays until noon, like me. Here's hoping to an easier week this go-around, especially since Anthony will be out of town.

EMC's Mad Men

Did you see this?



Perfect, love the opening especially, but they forgot the multiple scotches!