Yesterday a man arrived on Towne's front doorstep with 2 dogs, a bike, and what I assume were most of his worldly possessions. He was on his way from New York to Daytona Beach to stay with a friend and was walking the bike and the dogs when he couldn't hitch a ride. The dogs looked healthy but tired, and faithfully stood by their master's side.
Today I was reflecting on his journey and thinking how much more bearable the rough days must be (and how much nicer the good ones) with those companions by his side. Despite our different circumstances, we can all relate to that!
Tuesday, November 15, 2011
Tuesday, September 13, 2011
The Upside of All The Rain
After major rainfall, boaters like myself watch the Little Falls guage for the Potomac River. Normally at 2.5-3 feet during the dry summer, the river roars to life at 6 feet and a perfect surfing wave forms where Difficult Run flows into the river. 5-15 boaters wait in line in a narrow eddy to take turns carving up the wave. Even surfboards and stand up paddleboards were seen this past Sunday in perfect 80 degree sunny weather.
Easing your way up the eddy, you power across the eddy line into the current above the wave. A quick ferry across a minor standing wave moves you into position 15 yards above the target. You coast backward into the trough of the wave, then up the back until you are stopped by the breaking foam pile which, at lower levels, can turn into a sticky hole. Now though, it just stops your downstream momentum and you slide back up the wave face.
Now, although stationary relative to the shore, you are carvingback and forth across the water with thousands of cubic feet of river surging under and around you. Periodically the foam pile starts to break on your stern and you plunge deeper in to the oncoming water. Great Blue Herons fly over head. You dodge logs floating through the wave. You surf until the wave spits you out or you've had your fair time on it, then exit off the side and get in line to do it again.
Overall, an amazing way to spend a few hours on a Sunday afternoon!
Friday, August 12, 2011
What, is that Smell?
I love mentoring because I usually learn as much as the mentored. Yesterday I was discussing a case with Dr. Berning, our new associate. My patient, an elderly cat had presented with decreased appetite and lethargy. With a history of hyperthyroidism, multiple missing teeth and several strokes that had resulted in hearing loss, there were many possible causes. In addition, through x-rays and ultrasound, we had discovered a large cyst in front of his heart.
We decided to tap the fluid off the cyst using ultrasound guidance, hoping that, if this was the main problem, we'd see immediate improvement. We also temporarily stopped the thyroid medication since long term use can result in toxicity in some cats. Dr. Berning suggested that another factor might be loss of sense of smell due to the strokes. This made sense since he seemed to prefer fish based foods. With this in mind, we recommended offering these foods, either alone or on top of the regular diet, warming the food, and continued use of an appetite stimulant. Thanks Dr, Berning!
(Interestingly, this patient was exposed to debris from 9-11. Living a mile downwind, he was outside when much of the debris permeated this neighborhood. I don't know that the cyst is related, but cysts are unusual enough that the link must be considered.)
We decided to tap the fluid off the cyst using ultrasound guidance, hoping that, if this was the main problem, we'd see immediate improvement. We also temporarily stopped the thyroid medication since long term use can result in toxicity in some cats. Dr. Berning suggested that another factor might be loss of sense of smell due to the strokes. This made sense since he seemed to prefer fish based foods. With this in mind, we recommended offering these foods, either alone or on top of the regular diet, warming the food, and continued use of an appetite stimulant. Thanks Dr, Berning!
(Interestingly, this patient was exposed to debris from 9-11. Living a mile downwind, he was outside when much of the debris permeated this neighborhood. I don't know that the cyst is related, but cysts are unusual enough that the link must be considered.)
Monday, August 1, 2011
Germs vs Man
Another recent headline: Iodine, Alcohol Prep Pads in Kits Recalled. Guess why.
Bacterial Contamination! Add this to the list of food and pharmaceutical recalls that have taken place over the past several years due to chemical, bacterial, and particulate contamination. In today's mass manufacturing environment, it isn't suprising that these recalls occur, but bacterial contamination of antibacterial materials stands out. Imagine the fallout if a production lot of hand sanitizer became contaminated! This is yet another reason for common sense prevention-hand washing with regular soap and water, sterile technique in hospitals, and judicious use of antimicrobials.
Bacterial Contamination! Add this to the list of food and pharmaceutical recalls that have taken place over the past several years due to chemical, bacterial, and particulate contamination. In today's mass manufacturing environment, it isn't suprising that these recalls occur, but bacterial contamination of antibacterial materials stands out. Imagine the fallout if a production lot of hand sanitizer became contaminated! This is yet another reason for common sense prevention-hand washing with regular soap and water, sterile technique in hospitals, and judicious use of antimicrobials.
Dog Bite Prevention
A recent headline in one of our trade journals reads: "AVMA, Postal Service Join Effort to Prevent Dog Bites". Although this brings to mind an almost comical image of a mail carrier being nipped at by the family dog, anyone who has been bitten, myself included, knows this is no laughing matter.
Two stats from this article are worth noting. Medical expenses for the 5,669 postal employees that were bitten in 2010 amounted to $1.2 million. And one third of homeowners claims in 2010 were for dog bite related inuries, costing $413 million!
My two most memorable bites were early in my career. Actually the first was at a clinic where I was volunteering as a teenager. I was holding a large shepherd for an injection and he whipped around a grazed my shoulder. It didn't do much damage but seeing how easily my face could have been damaged gave me a healthy appreciation of adequate restraint and the ability to read body language.
The second was with a little terrier that I knew was a biter. She seemed relaxed so I carelessly reached into the cage and she bit me right through my fingernail. That little gift from her stayed with me for a good 3 months!
Biting is one of the most difficult behaviors to correct. Proper socialization and temperament testing can go a long way, so start early with your own pets and educate yourself and your children about approaching other dogs. More in this AVMA brochure.
Two stats from this article are worth noting. Medical expenses for the 5,669 postal employees that were bitten in 2010 amounted to $1.2 million. And one third of homeowners claims in 2010 were for dog bite related inuries, costing $413 million!
My two most memorable bites were early in my career. Actually the first was at a clinic where I was volunteering as a teenager. I was holding a large shepherd for an injection and he whipped around a grazed my shoulder. It didn't do much damage but seeing how easily my face could have been damaged gave me a healthy appreciation of adequate restraint and the ability to read body language.
The second was with a little terrier that I knew was a biter. She seemed relaxed so I carelessly reached into the cage and she bit me right through my fingernail. That little gift from her stayed with me for a good 3 months!
Biting is one of the most difficult behaviors to correct. Proper socialization and temperament testing can go a long way, so start early with your own pets and educate yourself and your children about approaching other dogs. More in this AVMA brochure.
Wednesday, July 27, 2011
How Doctors Think
I ran across this book on the Fairfax County Library Audiobook site. Not only has it provided an interesting perspective on how human medical doctors think through cases, but it has provided plenty of material for self-examination. There are many cognitive errors that can compromise a diagnosis, from being satisfied with the first answer we have evidence for (search satisfaction) to letting our relationship with a client unduly affect our recommendations (affective error). Dr Groopman illustrates these with real life examples and follows up with questions that you can ask your doctor when you think something might be being overlooked, such as "What else could be causing these symptoms?" A worth while read for anyone who might have to navigate through the human (or veterinary) medical landscape, and that means most of us.Wednesday, June 1, 2011
Mysteries of Life
Recently, my wife and children rescued tadpoles from a tire rut filled with rainwater. This vernal habitat has long since dried up, but 40+ tadpoles are thriving in our home. One of them wasn't looking so well so we removed him(?) from the tank. This prompted us to observe him in a little glass saucer with the 20-4ox power microscope we had gotten for homeschooling years ago.
First we looked at his eyes. I called my wife, the kids, and their friends who were visiting and they all lined up to look through the eyepiece. After many "oohs" and "aahs", I focused on the tail. There, in the transparent part of the tail that surrounds the spinal column, one could see individual blood cells traveling out along arterioles to the tail margin, then back through venules to the main vessels. This poor tadpole obviously wasn't moving much at this point, but his circulatory system was well enough for us to get an excellent view of the wonders of creation.
These same amazingly complex microscopic processes are going on throughout our body 24 hours per day, every day for decades. Unfortunately, we seldom recognize the beauty of biology until something stops working correctly. Mysteries still far outweigh our knowledge when it comes to life, but ever since veterinary school I've felt priveleged to be in a profession that allows me to care for patients within the bounds of that knowledge. (Sometimes that means just not interfering with the body's ability to heal.)
First we looked at his eyes. I called my wife, the kids, and their friends who were visiting and they all lined up to look through the eyepiece. After many "oohs" and "aahs", I focused on the tail. There, in the transparent part of the tail that surrounds the spinal column, one could see individual blood cells traveling out along arterioles to the tail margin, then back through venules to the main vessels. This poor tadpole obviously wasn't moving much at this point, but his circulatory system was well enough for us to get an excellent view of the wonders of creation.
These same amazingly complex microscopic processes are going on throughout our body 24 hours per day, every day for decades. Unfortunately, we seldom recognize the beauty of biology until something stops working correctly. Mysteries still far outweigh our knowledge when it comes to life, but ever since veterinary school I've felt priveleged to be in a profession that allows me to care for patients within the bounds of that knowledge. (Sometimes that means just not interfering with the body's ability to heal.)
Thursday, May 26, 2011
Awww...I want one!
I grew up with a beagle named, don't laugh, "Lassie". The family got her at "Puppy Palace" and on the way home my sister and I were asked to come up with a name. I didn't know any other dog names at that young age, so Lassie it was! She lived a long life and passed away when I was in college--I'm glad I didn't have to face that at the time. Now we have an odd looking but lovable mutt named Dusty, but there will always be a special place in my heart for beagles.
Saturday, May 7, 2011
It's a Girl!
Most Saturdays start off slowly and get busier throughout the morning. Today, however, we started off with an early emergency c-section on a young mom with one very large puppy. We were a little concerned because the meconium (fetal stool) was in the fetal sac, but this little girl did great and went home several hours later with a healthy start to life. Here she is:
Tuesday, April 5, 2011
Clinic Tour
The Front Entrance off the main parking area.
As you can tell from the reflection, we are ADA compliant!
Reception Desk
Client Lounge (with complimentary coffee and tea!) 
Saturday, March 5, 2011
Ribbon Cutting
In a quiet ceremony today, we had our official ribbon cutting. Mayor Kristen Umstattd and other town and county representatives gathered with the families of Dr Bollenbeck and Rice, a few of our staff and friends (and Dusty) to recognize our move to the new facility. Having delayed the original ribbon cutting ceremony, we were pleased to mark this milestone in our business' growth. When the nicer weather arrives, we will have an open house during which we will celebrate again with our full staff and clients. Stay tuned!
No Superbowl
One of our senior patients stopped eating suddenly. She would go up to the bowl but then not want to eat. We assumed her kidney values were up or her reflux had flared up, but blood work revealed no problems and there were no other GI symptoms. No evidence of dental issues or swallowing problems.....
This situation is common and a dilemma for us. Do we wait and see if our elderly patients are just having a few bad days and will get better on their own, or do we do additional tests and treatments which may or may not be helpful. Well, in this case, our client figured out the reason for the inappetance: a new shiny metal food bowl! Apparently, this kitty would see her distorted reflection everytime she went up the the bowl and was put off by it. A switch back to the old bowl solved the problem.
From now on, "new food dish?" is going to be on my list of historical questions!
This situation is common and a dilemma for us. Do we wait and see if our elderly patients are just having a few bad days and will get better on their own, or do we do additional tests and treatments which may or may not be helpful. Well, in this case, our client figured out the reason for the inappetance: a new shiny metal food bowl! Apparently, this kitty would see her distorted reflection everytime she went up the the bowl and was put off by it. A switch back to the old bowl solved the problem.
From now on, "new food dish?" is going to be on my list of historical questions!
Sunday, February 13, 2011
Our New Home
Well, we finally are in our new home! On Thursday, February 10, 2011, we moved from Market Street to Plaza Street and saw our first appointment Friday morning! Once we've unpacked more completely, we'll post some pictures, but we are up and running with few hiccups. The space is taking shape quickly and the work space is a welcome upgrade over our former facility. We look forward to seeing you and your pets soon. Stay tuned for our ribbon cutting and open house in early March.
Thursday, February 3, 2011
Ely: "I thought you said tutored!"
Here is a look behind the scenes of a surgical visit:
His check-in sheet tells us that he needs some preanesthetic blood work to make sure he can safely be sedated.
Ely arrives in the morning having skipped breakfast. Robin gets his weight sets him up in a comfortable cage with an ID collar. Ely wonders what neutering is. 
During his exam, the doctor determines that several baby teeth have not come out. 
After consulting Ely's mom, a plan is made to remove them under anesthesia. A medication is given to control pain and smooth out the anesthesia.
When this has taken effect and the blood work has come back normal, Ely is sedated with an injection and then put on oxygen and anesthetic gas for the procedure. Fluids and antibiotics are administerd as well. All goes well with surgery and the extractions, but an examination of Ely's ears under sedation show a large wax plug over the right ear drum. A loop is used to carefully remove it and the ear drum is healthy underneath. Our technician implants a microchip for identification and Ely goes to the recovery area. Later that day, Ely goes home with some additional pain medication for the next 48 hours.
(Even with a "routine" surgery, there are always individual considerations, and in this case the dental and ear issues were able to be addressed without a second anesthetic procedure. We love our hi-tech tools (ultrasound, anesthetic monitors, digital dental x-ray, in-house lab, etc.) but the foundation of good care will always be the physical exam! )
Reunited
Most folks have heard of microchipping their pet. A "microchip" is an inert rice sized bead that contains an electronic device that holds a code. When the chip is scanned, the scanner induces a signal in the chip that is transmitted to the scanner to reveal the code. If the code is registered with the microchip company, the owner's contact information can be used to contact them. Here's one story that I'll add to the mix of reunions facilitated by this technology:
A new client presented a wonderful cat that they had named Elvis for an exam. Elvis had been hanging out around their house and being fed by them for about 6 months when they decided to formally adopt him and get him caught up on his vaccines and deworming. We identified some significant dental issues that needed to be addressed and the client agreed to leave Elvis to have the dental procedures done.
Before I sedated Elvis, we scanned him and found a chip. I called the new client to let them know the news, knowing they would be disappointed if they couldn't keep Elvis. They graciously said that if Elvis was missing from a home, he could be returned, but they would love to keep him if the original family could not be found. Well, we did find his first family through the microchip company. Elvis had disappeared 6 months earlier and they were relieved to find that he had been taken care since then.
The original family did cat rescue work and had several other cats to care for, so Mrs. was willing to allow the new client to adopt Elvis, but she needed to check with her husband who had been very attached to Elvis. Fortunately, he also agreed to let the new client keep Elvis.
Even though a reunion ultimately did not take place, Elvis's former family has the peace of mind of knowing that he is in a good home. And Elvis had his dental work, is up to date on his routine preventive care, and is living happily in his new home!
Sign of the Times
Our new sign was installed recently--now Plaza Street is really starting to feel like home! Our improvements to the handicap parking spaces should be complete within a week if the weather holds out and hopefully we'll be moved in by mid February. The excitement builds!
Friday, January 28, 2011
The Twilight Zone
Great news:
Final building inspection: done!
Low voltage permit: done!
Sign: done!
Cat condo installation: done!
Phone installation and training: done!
Veterinary inspection: passed with flying colors!
Final zoning permit: delayed! Our goal of a February 1 opening date has been delayed until later in February due to some unforseen parking lot issues. This is a bump in the road, so to speak, of an otherwise smooth process, so we are taking this extra time to fine tune the transition. We'll update you as our move-in date gets closer.
Ahh, the best laid plans of mice and men...
Final building inspection: done!
Low voltage permit: done!
Sign: done!
Cat condo installation: done!
Phone installation and training: done!
Veterinary inspection: passed with flying colors!
Final zoning permit: delayed! Our goal of a February 1 opening date has been delayed until later in February due to some unforseen parking lot issues. This is a bump in the road, so to speak, of an otherwise smooth process, so we are taking this extra time to fine tune the transition. We'll update you as our move-in date gets closer.
Ahh, the best laid plans of mice and men...
Sunday, January 9, 2011
We're Floored
The floors are in and looking good. We chose tile for the reception/waiting area for a durable, attractive surface.
Final finishing touches are in progress. Next comes equipment and kennel installation along with a myriad of final inspections.
The clinical areas have industrial sheet vinyl with heat welded seams.
The epoxy kennel floor is tough, water proof, and easy to keep clean.
Final finishing touches are in progress. Next comes equipment and kennel installation along with a myriad of final inspections.
Sunday, January 2, 2011
Veterinary Tiles
Happy New Year! One month to go on our clinic buildout. We are at the flooring stage-last week the tile was laid and next week the vinyl will be going in. We are still aiming for a Feb 1 start date but will let you know when the date is finalized. 
Subscribe to:
Posts (Atom)