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A rainbow flag went up in our ultrasound room around noon today. I glanced at it, went "huh," and went back to work. Didn't figure out why it was there until I finally logged into Facebook fifteen minutes ago. Proof that, given a large enough volume of blocked cats, foreign bodies, and laceration repairs, I can remain oblivious to absolutely anything. ;D
 
Today is a good day. I got 11 hours of sleep last night and woke up feeling normal for the first time in a few weeks. It's raining and cool outside, so no AC needed. Lots of Netflix and junk food today. 🙂
 
psilovethomas said:
Today is a good day. I got 11 hours of sleep last night and woke up feeling normal for the first time in a few weeks. It's raining and cool outside, so no AC needed. Lots of Netflix and junk food today. 🙂
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Sounds like my day minus 11 hours of sleep. I have been sleeping on and off today since I'm on call. Went back in so owners could feed their dog again(he's only eating for them right now) and was treated to a wawa gift card.
 
Figured I'd use my little monster's neuroses and sorting skills for good today so he went for his first herding lesson. The puppy absolutely loved it!

 
Former classmate B moved in with me last week. So far everything is great. Loki (boy cat) has warmed up quickly to him, to the point of begging for food when B is in the kitchen (despite the fact that B has never fed him). Kuromi (girl cat) is being her usual skittish self and has been mostly hiding in my room except for feeding and using the litter box. Tonight though she finally emerged to have a look around the living room while B and I were watching television. She even jumped up onto my lap for a few minutes even though it meant being just a few feet from B. Progress!
 
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I'm super late to the Netflix game...but just had my first ever all-day series binge. Omg...so amazing. Only 7 more shows to strike off my summer list. Was what I was doing even considered living before this???
 
^awww

A lot of times the island gets to me and I want more than anything to go home but last night was not one of those nights! The St. Kitts music festival was this weekend and they brought Trey Songz and Jason Derulo down and the concert was phenomenal! I was about 3 rows back from the front and that is wayyyy closer than I would have gotten to the stage for $40USD back in the states.
 
allieh8607 said:
^awww

A lot of times the island gets to me and I want more than anything to go home but last night was not one of those nights! The St. Kitts music festival was this weekend and they brought Trey Songz and Jason Derulo down and the concert was phenomenal! I was about 3 rows back from the front and that is wayyyy closer than I would have gotten to the stage for $40USD back in the states.
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SO JEALOUS! Jason Derulo is my faaaave!
 
pooter said:
A rainbow flag went up in our ultrasound room around noon today. I glanced at it, went "huh," and went back to work. Didn't figure out why it was there until I finally logged into Facebook fifteen minutes ago. Proof that, given a large enough volume of blocked cats, foreign bodies, and laceration repairs, I can remain oblivious to absolutely anything. ;D
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That's how I felt. I saw some post on Facebook about how SCOTUS has "really been bringing it" this week (presumably in regard to both ACA and marriage), and thought "Huh? What? Did they rule on something?"

Sigh.

I mean, I firmly believe both rulings were the correct decision, but geez ... I feel out of it. Just trying to keep my head above water.
 
Saw a case that I just knew in my gut was Addison's despite not having the classic bloodwork. Hyponatremic but normal potassium. My boss scoffed at me for running an ACTH stim test and basically said in an indirect way that I was wasting the client's money. Got results back today and boom-Addison's! I totally felt justified and I am glad I trusted my gut.
 
So I woke up this morning, and first thing went to my freezer to get my double caramel magnum bar that I proceeded to eat naked in my bed totally dorsally recumbent. Little pieces of chocolate kinda fell on my neck so I just kind of wiped them off with my finger and licked them off. No doubt I have residual chocolate smeared on my neck. The whole thing was too sweet for my taste, so I gobbled it down rather than savoring it.... So that I can just move to my cherry Garcia bar before going down for a nap. I have to say, this is a great way to kick off my 4 day weekend!

Tub o' larding with a cat by my side.
 
Minnerbelle said:
So I woke up this morning, and first thing went to my freezer to get my double caramel magnum bar that I proceeded to eat naked in my bed totally dorsally recumbent. Little pieces of chocolate kinda fell on my neck so I just kind of wiped them off with my finger and licked them off. No doubt I have residual chocolate smeared on my neck. The whole thing was too sweet for my taste, so I gobbled it down rather than savoring it.... So that I can just move to my cherry Garcia bar before going down for a nap. I have to say, this is a great way to kick off my 4 day weekend!

Tub o' larding with a cat by my side.
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Pics or it didn't happen. 😉
 
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Jilary said:
Pics or it didn't happen. 😉
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ImageUploadedBySDN Mobile1435843873.943540.jpg


Just the kitty part 😉
 
Lissarae06 said:
Saw a case that I just knew in my gut was Addison's despite not having the classic bloodwork. Hyponatremic but normal potassium. My boss scoffed at me for running an ACTH stim test and basically said in an indirect way that I was wasting the client's money. Got results back today and boom-Addison's! I totally felt justified and I am glad I trusted my gut.
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Addison's aside .......... Wouldn't it be nice if the public could hear some of our conversations? I mean, I'm glad you went with your gut - but it says something good about your boss that he was concerned with wasting the client's money, whereas the normal perception is that we're back there scheming for ways to take more from them. Nobody realizes how much we stew over how to spend their money to get the best results.
 
Lissarae06 said:
Saw a case that I just knew in my gut was Addison's despite not having the classic bloodwork. Hyponatremic but normal potassium. My boss scoffed at me for running an ACTH stim test and basically said in an indirect way that I was wasting the client's money. Got results back today and boom-Addison's! I totally felt justified and I am glad I trusted my gut.
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It totally feels good doesn't it?

I've had this very difficult/involved medicine case that I've been working on for the past few months. I told the owner the very first day that based on clinical signs and some lab results from a year ago, we were going to need quite a few involved and expensive testing before we can get to treating what I think we are going to need to treat because we need to rule out a bunch of more common things first (despite them not being as likely based on minimal database). The owner was very frustrated that I could not guarantee that any one test will give the diagnosis, and that in the end we are going to try and get to a diagnosis of exclusion. He kept threatening to go for a second opinion... and was taken aback when I said please do, I highly recommend a medicine consult. That with the condition I'm suspecting, I need him to trust me fully to proceed. Well anyway, we've been slogging through this and that while we were taking care of a possibly unrelated infection. It got to the point where the next step was AUS. So I convinced them to go for a medicine consult for the AUS. I got the report back, and the list of differentials were exactly the same as mine. And the next steps listed were exactly what I told the owner what we would likely need to do at the first visit even before we got the minimal database!
 
I have an amazing support staff of assistants and technicians. (And yes, I tell them frequently how much I appreciate them). Example - one of our assistants was in yesterday evening tending to the boarders while I was taking in a Pomeranian attacked by a dog. She didn't even flinch or hesitate when I asked her if she could give me a hand and didn't even complain about the blood on her sweater.
 
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Minnerbelle said:
It totally feels good doesn't it?

I've had this very difficult/involved medicine case that I've been working on for the past few months. I told the owner the very first day that based on clinical signs and some lab results from a year ago, we were going to need quite a few involved and expensive testing before we can get to treating what I think we are going to need to treat because we need to rule out a bunch of more common things first (despite them not being as likely based on minimal database). The owner was very frustrated that I could not guarantee that any one test will give the diagnosis, and that in the end we are going to try and get to a diagnosis of exclusion. He kept threatening to go for a second opinion... and was taken aback when I said please do, I highly recommend a medicine consult. That with the condition I'm suspecting, I need him to trust me fully to proceed. Well anyway, we've been slogging through this and that while we were taking care of a possibly unrelated infection. It got to the point where the next step was AUS. So I convinced them to go for a medicine consult for the AUS. I got the report back, and the list of differentials were exactly the same as mine. And the next steps listed were exactly what I told the owner what we would likely need to do at the first visit even before we got the minimal database!
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I keep staring at AUS hoping that the words will jump into my brain as to what those letters stand for. Then I turn to google which gives me a whole lot of Australia.

Anyway, please help my acronym challenged brain. Thanks! 🙂
 
Lissarae06 said:
Thank you! I wasn't sure what it was either.
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Huh it must be a regional thing. I've seen it acronymed that way in med records in just about every clinic I've gotten records from including the teaching hospital. I didn't realize that it wasn't a thing elsewhere. Lol I may have to consider writing it out in my medical records.

AUS, CXR, AXR for our main imaging modalities. Though we're not weird and do call echocardiograms echo, and not CUS...
 
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Minnerbelle said:
Huh it must be a regional thing. I've seen it acronymed that way in med records in just about every clinic I've gotten records from including the teaching hospital. I didn't realize that it wasn't a thing elsewhere. Lol I may have to consider writing it out in my medical records.

AUS, CXR, AXR for our main imaging modalities. Though we're not weird and do call echocardiograms echo, and not CUS...
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We use pretty much the same here.
 
dyachei said:
i've seen LIS say AUS before
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I see AUS almost always, and the odd U/S but I don't think I see US ever. Weird how that works.

I don't have EMR, so even though I started out never short handing anything... I realized that when I have 20 appointments in a day, it really really sucks not to abbreviate and have succumbed to having random letters everywhere. It would make a client's head spin if they wanted a copy to look over.

I figured it's better to have something written denoting that I did look at these things, than just having significant findings written. CYA and all.
 
Minnerbelle said:
I see AUS almost always, and the odd U/S but I don't think I see US ever. Weird how that works.

I don't have EMR, so even though I started out never short handing anything... I realized that when I have 20 appointments in a day, it really really sucks not to abbreviate and have succumbed to having random letters everywhere. It would make a client's head spin if they wanted a copy to look over.

I figured it's better to have something written denoting that I did look at these things, than just having significant findings written. CYA and all.
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Even with EMR I'm so stacked deep in clients on some days (wait times of hours..... Yay......) that I acronym the heck out of it. Honestly - and this sucks - I'm less concerned with my client being able to read my exam/diagnostic/SOAP notes than I am with me later being able to say "PERL means pupils equal and responsive to light, so yes, I did look at the eyes". I do make sure the client-focused portion of the discharge isn't filled with confusing language, though.

But yes, I use AUS frequently. Occasionally U/S as well. Never US because that's short for United States. No, that's not very rational of me.

I agree that I like to have something documenting that I at least looked. I do tend to write a whole lotta WNL nowadays, but when able I do my best to flesh it out.
 
LetItSnow said:
Even with EMR I'm so stacked deep in clients on some days (wait times of hours..... Yay......) that I acronym the heck out of it. Honestly - and this sucks - I'm less concerned with my client being able to read my exam/diagnostic/SOAP notes than I am with me later being able to say "PERL means pupils equal and responsive to light, so yes, I did look at the eyes". I do make sure the client-focused portion of the discharge isn't filled with confusing language, though.
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Ooh, when I had EMR, I had an awesome complete template of normals that sped up the process a ton. I just deleted things I did not actually check (like the oh crap, I didn't check testicles on the super aggressive bulldog with the emergency hot spots... But the freaking chart says intact and I'm not sure I believe it), and type in the abnormals.

I don't care so much about the client being able to understand it, but I do know that there acronyms can be problematic if another doctor in or out of our practice needed to read the records. I would not know what you meant by PERL at all... And clearly AUS is an issue (who knew)! If I had a neuro patient, but cranial nerves weren't an issue, I just say cranial nerves intact. But if cranial nerves were an issue, I don't shorten beyond PLR WNL OU, no anisocoria/strabismus.

But holy hell, with all the allergy animals I see in a day, it gets tiresome. Assessment is usually like, Mod malassezia otitis AU likely secondary to allergies -r/o: FAD vs AD >> CAFR. And I don't give a care in the world that not everyone writes food allergies as CAFR. I'm not writing all of that out ten times a day. I figure there are enough clues there for people to figure it out. Sometimes I will write fleas vs atopy vs food... But I don't really like that much either. I pretty much have it there so that I can infer how suspicious I was of food or fleas for the next time the pet has a flare up and we need to step it up in terms of actually dealing with the allergies.

LetItSnow said:
But yes, I use AUS frequently. Occasionally U/S as well. Never US because that's short for United States. No, that's not very rational of me.
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Omg that's hilarious. I almost said the same exact thing about US but the refrained because I thought that was just lame.
 
Minnerbelle said:
Ooh, when I had EMR, I had an awesome complete template of normals that sped up the process a ton. I just deleted things I did not actually check (like the oh crap, I didn't check testicles on the super aggressive bulldog with the emergency hot spots... But the freaking chart says intact and I'm not sure I believe it), and type in the abnormals.

I don't care so much about the client being able to understand it, but I do know that there acronyms can be problematic if another doctor in or out of our practice needed to read the records. I would not know what you meant by PERL at all... And clearly AUS is an issue (who knew)! If I had a neuro patient, but cranial nerves weren't an issue, I just say cranial nerves intact. But if cranial nerves were an issue, I don't shorten beyond PLR WNL OU, no anisocoria/strabismus.

But holy hell, with all the allergy animals I see in a day, it gets tiresome. Assessment is usually like, Mod malassezia otitis AU likely secondary to allergies -r/o: FAD vs AD >> CAFR. And I don't give a care in the world that not everyone writes food allergies as CAFR. I'm not writing all of that out ten times a day. I figure there are enough clues there for people to figure it out. Sometimes I will write fleas vs atopy vs food... But I don't really like that much either. I pretty much have it there so that I can infer how suspicious I was of food or fleas for the next time the pet has a flare up and we need to step it up in terms of actually dealing with the allergies.



Omg that's hilarious. I almost said the same exact thing about US but the refrained because I thought that was just lame.
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I had to google CAFR... 🙁

I knew the food part, but couldn't figure out the rest for sure...

See, I suck at acronyms. I am sure I will get better with time, but it almost seems like it would be beneficial to have a universal acronym code in veterinary medicine so that everyone is on the same page as to what to use. I am already trying to shorten as much as I can with what I know to be acronyms we have used in school, because even with those acronyms some patients can take a good 30 minutes or more to type up information about them and when you multiply that by 3 or 4 patients (or 15-20 in "real life"), it is quite a task.

Also, this is where I could rant about how in some rotations they want you to make "notes" about "normal". It is unacceptable to say under cranial nerve exam: "all cranial nerves intact". I must type out every single cranial nerve test and exactly what happened and which cranial nerves are deemed "intact" because of each exam. So it takes much longer to type up a case because simply typing "normal" is not acceptable. (ok /rant in rave thread).
 
DVMDream said:
I had to google CAFR... 🙁

I knew the food part, but couldn't figure out the rest for sure...

See, I suck at acronyms. I am sure I will get better with time, but it almost seems like it would be beneficial to have a universal acronym code in veterinary medicine so that everyone is on the same page as to what to use. I am already trying to shorten as much as I can with what I know to be acronyms we have used in school, because even with those acronyms some patients can take a good 30 minutes or more to type up information about them and when you multiply that by 3 or 4 patients (or 15-20 in "real life"), it is quite a task.

Also, this is where I could rant about how in some rotations they want you to make "notes" about "normal". It is unacceptable to say under cranial nerve exam: "all cranial nerves intact". I must type out every single cranial nerve test and exactly what happened and which cranial nerves are deemed "intact" because of each exam. So it takes much longer to type up a case because simply typing "normal" is not acceptable. (ok /rant in rave thread).
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Well... If you're in neuro as a student, a complete neuro exam is probably indicated with a full record 😉. Some students don't really know how to test all cranial nerves. A lot of it is more about exercise. I know neurologists who will just state CNN intact if the issue is clearly not over there.

In practice, I tailor it to what the patient needs. For an anal gland abscess I ain't got no time for wheelbarrowing. If it's a strongly suspected cruciate, I at least do postural reactions and note that those are normal. I will likely not do a patellar reflex.

And don't sweat it, each department/clinician has their own SOAP rules and there is no way to know until they actually explain it to you or yell at you for doing it wrong. Trying to guess ahead of time or being worked up over it is a waste of your energy. Once you're on your own, you choose your own style as long as your employer is okay with what you're doing.
 
Minnerbelle said:
And don't sweat it, each department/clinician has their own SOAP rules and there is no way to know until they actually explain it to you or yell at you for doing it wrong. Trying to guess ahead of time or being worked up over it is a waste of your energy. Once you're on your own, you choose your own style as long as your employer is okay with what you're doing.
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This is so true. Even in the same department. Luckily I haven't been "yelled" at really, at least not yet. I have been sent emails during this last rotation. One telling me I didn't input the bloodwork (it was still pending). I just do my thing and if they have an issue, I usually find out.

The only ones that have really "bothered" me are those that I couldn't have done because the information wasn't available, yet I am still being told that I "forgot or didn't do it". I can't "forget" something that doesn't exist.

Oh well, silly clinicians.
 
Minnerbelle said:
I would not know what you meant by PERL at all... .
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Fortunately you wouldn't need to know what I meant by PERL. Our template is by system/region, so under eyes you'd see "Eyes: WNL - OU no discharge or hyperemia. PERL, normal menace and palpebral. No blepharospasm." Or some such language, depending on the patient's bigger picture.

So once you saw WNL you could move on. The rest is just there so I can later say "I did look and nope, I didn't see X at that time." So I sorta combine the WNL with adding notes. Though admittedly if I'm way behind there will be a lot less verbiage.

I like to think some stuff can be figured out. If I have an inappetent barfing lethargic dog that I've hospitalized overnight before sending it back to you (the GP) and all over my records it says things like "suspected hepatobiliary disease" and there is language about recommending internal medicine work-up with anticipated AUS....... I dunno. I think that one should be <reasonably> clear? Out of context probs not, but.....

I definitely try to make my notes useful to the rdvm. No point in baffling them - that's no good for anyone.
 
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LetItSnow said:
I definitely try to make my notes useful to the rdvm. No point in baffling them - that's no good for anyone.
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Even if something can't be figured out, the telephone is a wonderful invention.... 😉


I know the ER clinics near where I worked would call the rDVM and give them a brief history prior to transfer and vice versa. Not sure if that is the same in other places though. But again, if something is confusing, phones and talking works really well. 🙂
 
DVMDream said:
Even if something can't be figured out, the telephone is a wonderful invention.... 😉


I know the ER clinics near where I worked would call the rDVM and give them a brief history prior to transfer and vice versa. Not sure if that is the same in other places though. But again, if something is confusing, phones and talking works really well. 🙂
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Yeah. Rdvms often call us before sending something over, but I rarely have time to call them before sending it back. In an ideal world I would, for sure, but it's life. They get a fax copy of records before the animal leaves the hospital though, at least.
 
LetItSnow said:
Yeah. Rdvms often call us before sending something over, but I rarely have time to call them before sending it back. In an ideal world I would, for sure, but it's life. They get a fax copy of records before the animal leaves the hospital though, at least.
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Yeah, that's understandable. If they have questions, they can always call.
 
Had an owner that actually let me run titers to diagnose Toxoplasma myositis. Every once in awhile it's nice to see something out of the ordinary to make me feel like I'm not just missing things.
 
LetItSnow said:
Yeah. Rdvms often call us before sending something over, but I rarely have time to call them before sending it back. In an ideal world I would, for sure, but it's life. They get a fax copy of records before the animal leaves the hospital though, at least.
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That was my attitude as well when I did ER. I mean, I was waaaay too busy that I honestly didn't care if some rDVMs preferred to send some cases elsewhere... and while I was courteous if they contacted me, I didn't really care much about the rDVM no matter how true it might be that they are our true clients (Yeah yeah horrible associate, but seriously I was just so burned out I got to this level of apathy that I didn't know was even possible).

But now that I'm on the other side of the fence, I have to say I've been blown away by one of the ERs in the area. For any non quickie sort of case, I get a call from either the surgeon or criticalist usually prior to discharge as well as after the first day in the hospital after I transfer the case over. They'll run the case by me, and make sure that I'm comfortable with the plan moving forward. If it's a diabetic or something like that where I would have to manage long term, they'll ask me if I have a preference in drug choice before making their recommendation to the owner. As a result, I feel like I have a strong relationship with this particular ER, and feel much more comfortable sending a patient there over the other ERs in the area. If there is an adverse outcome, I feel super comfortable pow wowing with them to see if there was anything I could have done differently on the initial receiving end of things to have possibly made a difference.

It's really not something you can do much about if that's not the culture at your facility, but boy, that communication makes a huge difference.
 
Got a text with a picture of my one patients today. He was borderline stable when I took him on again (he was hospitalized twice in a week). He looks so good right now! Teared up a little bit. Reminds me why I love this field.
 
I totally missed that a barcade opened downtown about six months ago, and just got an ad on FB that they're holding a fundraising night for one of my favourite local animal rescues this week.

Hell. Yes. DDR and beer all night long! So excited.
 
Trilt said:
I totally missed that a barcade opened downtown about six months ago, and just got an ad on FB that they're holding a fundraising night for one of my favourite local animal rescues this week.

Hell. Yes. DDR and beer all night long! So excited.
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We used to have an awesome barcade in my town, but they closed down a couple months ago. 😢 I wasn't surprised though, they were super cheap so it seemed like there were always things in need of repairs. They didn't have DDR, though, that would have been the icing on the cake!
 
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