Thanksgiving

I have a lot to be thankful for, but the relationships I have at work are some of the great treasures:

First, our patients. I don't really need to explain the "human-animal bond" if you are reading this blog. But it is evidenced by the frequent focus of holiday gathering conversations on our pets. Just mention your cat or dog and see how many stories this prompts!

Second, our clients. The nature of our business tends to bring us compassionate individuals. The relationships we have with them are one of the most satisfying aspects of our profession. We realize we are not just treating pets--we are keeping the human-animal bond healthy too.

Third, our employees, our second family. One of the rewarding parts of owning a small business is being able to provide a livelihood for our employees. Their dedication to our business has given us the opportunity to focus on their needs as well as those of our patients. They laugh, cry, study, learn and trouble shoot with us. We enjoy the satisfaction that comes from a job well done.

Finally, Jason Bollenbeck. Jason is one of the closest and most trusted individuals in my life. He is a man of integrity and dedication to his profession and the community. He has selflessly supported my role as a husband and father and has helped make me a better person. I couldn't have been given a better friend to live the dream of owning and now building our own veterinary hospital.

Details

Other than the delivery of countless sheets of drywall, this is the stage of the buildout where nothing seems to be happpening at first glance, but on closer inspection many infrastructure items are going into place:

Wall insulation

Wiring for the wall outlets

HVAC duct work

and lots of Plumbing!

My Little Princess

This isn't a veterinary or building post, but a dad story. Sunday our youngest turned six and had a princess-tea party-castle pinata-castle cake party with a few of her friends. The highlight was a doll house present that she opened earlier in the day and matching accessories that her friends gave her as gifts at the party. Of course, she played with the house all day long, well into the evening and all the next day. Rebecca has quite a vocabulary so we are used to her "grown-up" phrases, but her comment to my wife last night ranks in the top ten. Reflecting on her new present she said:

"Mom, that dollhouse has completely changed my life!"

(I guess I could say the same of the new clinic buildout)

Looking Up

Here is another view from the entrance of the new clinic. This structure will support the lights and ceiling over the reception area. As you turn to the right you can see the waiting area. Since the ceililng grid is in, the ceiling height walls are also going up. The exam rooms are on the left and seating will be on the right. One client bathroom door is visible on the far wall to the left. Insulation partially hides the door to the store room. It is becoming more difficult to keep up with the pace of building, but we are happy to have that challenge!

Purrposeful Living

Yesterday I was examining a cat who was very much at peace with the world. This kitty was purring the entire visit! As I checked his ears and eyes, joints, lymph nodes, teeth and abdomen, he just kept on purring. I had to listen to his heart for twice as long as usual just to make out the heart sounds under the vibration. The more I examined, the more he purred.

Amused by how happy this cat was, I remarked to the client, "Don't you wish we could be that content all the time?"

Later on I was thinking about that visit and how the responsibilities of our lives do sometimes distract us from the simple pleasures that add beauty to our lives--fall leaves, a brisk fall morning, the great sunsets of this past week, and the relationships with people around us. I realize that in today's world we need to be on our guard, but hopefully our pets remind us that it is wise to purr once in a while. Enjoy relationships with our fellow human beings. Look for the good in others. Get excited just to go on a W-A-L-K.

Perspective

Construction is moving at an amazing pace. All the pre-planning is paying off as we see our dream become reality with relatively few "change orders" and surprises. Recently the floors were laid out. Although the marks on the concrete are the same as the ones on the drawings, some of the rooms looked alot smaller to us once they were laid out.


Once the walls started to go up things sure looked different. The rooms regained their dimensions and looked "normal " again. These are the full height walls that separate the sections of the clinic for sound and ventilation control. Later the dropped ceiling height walls will go in.

The walls now have one side with drywall until the electric and plumbing is in place. These views are all from the front entrance.

Post Blog Post

We have to enclose our dumpsters as part of our zoning approval. This past week, the posts for the enclosure were installed. I was picturing 4x4 pressure treated posts and was concerned about how sturdy they would be. But what we got were HEAVY DUTY metal posts that will probably still be standing in 200 years. As long as they can take trash truck abuse! Next up:fencing.

The Three Birds of the Thorax

One of my veterinary professors who taught cardiology had this corny but memorable joke:

Q: What are the three birds of the thorax?

A: The vagoose, the esophagoose and the thoracic duck! (a play on vagus, esophagus and thoracic duct)

Anyway, that's my segway into the state of construction. Here is the current view from the entrance (I'll try to be consistent with this view so you can see the progress from the "front door".)

Piles of dirt, drain pipes, pieces of duct work and construction equipment cover the floor as Bad Company pours over the boom box in the corner. The electrician arrived while I was taking these pictures. Soon they will run their lines and the concrete pourers will fill in the cuts to the floor.

Some of the ducts are already in place in preparation for the new HVAC unit.

This final picture shows the floor cut for the trench drain that will be in front of the dog runs in the kennel. We can't wait to give our first tour!

Concrete Cuts

The past several days have seen additional demolition and the cutting of the concrete slab to allow the plumbers to lay new drains. Some of the cuts are just through the slab, but most involve 4-5 foot trenches to get to the main building drain pipes. Yesterday the space was a huge cloud of dust as the concrete saws, jackhammers and heavy equipment broke up the slab. This morning a sole worker stood chest deep in a hole digging the final foot of dirt around the main drain.

Meanwhile central vacuum and anesthetic scavenging (removing waste gas from the building) parts and pendant lights are starting to fill up our office as we stockpile supplies for later stages of construction.

After months of drawings, it is exciting to see real physical changes taking place!

In Memory of Lexy

This is Lexy. Fifteen years old and all of 3.4 pounds, she is a beloved pet of one of our long time clients. We didn't know her when she was a youngster, but she has been a patient here for 5 years and over that time has surprised us with her resilience. Her most recent illness involved a bad kidney infection that almost took her life. Although she appeared quite fragile and was guarded at best in her prognosis, she rallied and recovered. And while even a younger, stronger dog would have needed intensive care for several days to pull through, she did so through the loving comfort of her "mom's" arms and outpatient visits at Towne.

Every visit brought more encouragement as her kidney values came down and her health improved. Yesterday her values were almost normal, she had gained back her weight, and her mom and I talked about long term followup. We said "see you in a month" and both went about our days, mine at church with my son's boy's club, and her at her daughter's Girl Scout meeting.

At home Lexy walked up stairs, curled up in her bed, and peacefully left this life. I'd like to think that she had conquered her illness and was ready to leave on her own terms. Perhaps we should just be thankful for the gentleness that characterized the substance and end of her life.

Demolition Derby

Demolition of the new clinic space began today. As you can see, the walls are coming down and the ceiling tiles have been removed.

Althought this is a dirty job, you've got to admit that this worker has found a good way to relieve construction headaches:
Next up: Concrete cuts for the plumbing!

This is why I haven't blogged since February

Earlier this year, Dr. Bollenbeck and I finally found a permanent home for Towne Animal Clinic. Although our current space at 338 E Market has served us well, "this old bank" is not the ideal clinic setting. We're also outgrowing the facility and needed to make a decision before our lease came up for renewal. So we've purchased 64 Plaza Street and are about to begin demolition next week!


Getting to this point has involved many hours of study, planning, and debate, quite a few meetings with the Town of Leesburg, and making hundreds of decisions from "Do we move?" to "What style of pendant light?", but we are very excited to finally be breaking ground. It will take about 4 months to complete the project with a tentative move in date of February 1, 2011.


The new clinic is directly across from the new Town Fire and Safety Station, very close to our current location. Upgrades to our current space will include:


Indoor dog runs
Handicap Accessible Entrance
Mens and Womens Bathrooms off the lobby!
Dedicated imaging center for X-ray and Ultrasound
Two Table Surgery Suite
Four Exam Rooms
A Break Room for our Staff
Cat Condos


I'll try to post regular photos of the construction as the various stages are completed. Here are some pre-demo pictures.

Dusty and Me

My wife, our older kids and I just watched "Marley and Me" and, like any one who is owned by a dog, found Marley's antics humorous and somewhat familiar. Dusty is much better behaved but still has provided some memorable moments--helping himself to cookies off the kitchen table, bounding through the woods behind our house in pursuit of deer, bouncing at the front door as his master arrives at home. He is a young dog, so some of the more tearful moments of the movie are a long way off, but I try to remind myself frequently to "live in the moment" and appreciate that connection with Dusty now. Of course, dogs are excellent at living in the moment! No anxiety about tomorrow, no regrets about yesterday. Just seeking a masters touch with a gentle but persistent nudge. Well, what do you know, here he comes. Gotta go!.

A Difficult Call

Dr Bollenbeck found a mass growing inside this dog's eye (the pink circular mass in the center of the picture). This 10 year old is a great companion and belongs to one of our best clients. The location of the mass was a little unusual but the appearance strongly suggested cancer. After an extensive search to make sure that there were no other tumors elsewhere, a decision had to be made about surgery. Should the tumor be removed (which means removing the eye), or should we watch the mass to see if it grows? Fearing that further growth might cause it to spread outside the eye, the decision was made to remove it. Good thing we did, as the biopsy revealed a carcinoma. A difficult decision but the right one for this dog's long term health.

This case highlights a unique aspect of veterinary medicine. Our patients experience little psychological stress from the loss of eyes, ears, limbs, teeth, testicles or ovaries. As dog and cat lovers, we are often affected more by the resulting change than they are. Pets, if they are pain-free and can function socially within the family, live pretty contentedly regardless of their appearance. Just look how happy Pugs are!

OUCH!

Believe it or not, these are just some of the bladder stones from one dog. I've only seen 2 dogs in 20 years of practice with this particular type of stone. Most stones are made of calcium-oxalate, magnesium-ammonium-phosphate or urate. These unique stones are silica and have a "jackstone" appearance. Noone knows why some dogs get them. This patient had several lodged in his urethra and was quite painful. Fortunately, I was able to use a technique called urethrohydropulsion to flush them back into the bladder where they were easily removed. Without this technique, they have to be removed by an incision into the urethra with a resulting painful, complicated recovery. Few men wouild have trouble sympathizing with this dog, but the good news is that he was feeling great within a few days!

FANG-FANG

One of the reasons to wait until 6 months to spay or neuter a dog or cat is shown above. The upper canine tooth (fang) has come in, but the baby fang behind it never fell out. This is an extremely common problem, especially in toy breed dogs, and will be apparent by 6 months of age. This is when most dogs would have had the permanent canine teeth erupt. While pets are under anesthesia, the baby teeth can be extracted, eliminating the crowding of the teeth. This is a delicate procedure since the baby teeth enamel is very thin, but one that pets recover from very quickly. Neutering or spaying can be done as early as 12 weeks of age, but if retained baby teeth have to be removed later, there is the additional cost of a second anesthetic procedure. Worse, pet owners may not notice the retained teeth, and the problem may not be addressed until the next exam. By that time, damage to the teeth and gums may have occurred.

The orange tube delivers oxygen (see the nice pink gums!) and anesthetic and allows us to "breathe" for our patient as need. The rubber bands help to gently hold the tube in place while being easily repositioned during the extraction. A nerve block has been done (hidden by the upper lip) to minimize any discomfort from the extraction.

So that's a lipoma!

Many who have had a dog with a few extra pounds around the waist have seen lipomas develop under the skin. These are benign, slow growing tumors. Ususally we recommend leaving them alone, but occasionally we'll remove lipomas that are in awkward locations like the axilla (armpit). Frequently, these lipomas are encapsulated and come out in one large "glob". This is an example of such a lipoma. It was fist size and probably weighed 2 pounds. It is surprising how little blood supply there is to these tumors. In fact, the major surgical challenge is eliminating all the space that the lipoma took up so that the space doesn't fill up with fluid after surgery. There is no liposuction done in dogs, but this comes close!

Microsurgery

This was a satisfying surgery on a rat with an ear tumor. Fortunately, the mass was attached to the margin of the ear, so I was able to remove part of the ear without having to compromise the canal or any major blood vessels or nerves. The black device is a mask that delivers the anesthetic gas. A little lidocaine cream on the surgery site kept this rat from scratching at the ear when it woke up. Total time: 10 minutes! (The length of anesthesia is critical--small critters cool off and can get dehydrated pretty quickly.)

What's in the box?

Today is one of those days that reminds my staff and me that our role in the end of life issues is just as important as all the preventive care and treatment we do. In addition to our regular appointments, we have 2 euthanasias scheduled and 2 clients who had to bring in pets that had passed away at home after long illnesses. So far they have all elected to have their pets cremated privately and the ashes returned to them.

About half our clients choose this option, as opposed to a group cremation and burial. In less than a week, they will receive a small wooden box. What's in the box?

Stopping by the shelter "just to look".
Having said yes to having this pet in their lives.
The joys and challenges of puppy- and kitten-hood.
An interior re-decorator.
A mood lifter.
Enthusiastic tail wagging or purring.
Encouragement to take a walk.

A "child" who didn't grow up and go off to college.

Years of companionship.
Unconditional love.
A nonjudgmental friend.
A part of themselves.

...and ashes.

A Day in the Life

6am-- Awaken, shower, dress, eat
7am--Leave to drop off boys at their carpool for school
7:15-7:45--Listen to book on tape (currently Red Mars)
7:45--Morning period of meditation in car before going into work
8am-noon--

• Vomiting dog emergency and hospitalization, x-rays, ultrasound
• Call about dental scaler repair
• Two very friendly pit bulls for vaccine visit
• Call Saturday's client about thyroid levels and plan for additional diagnostics
• Second cup of coffee--only 2 sips
• New (extremely cute) Puppy Visit
• Dog Puncture wounds from other dogs attacks

Noon--Enter Quickbooks entries from Saturday.

12:30-2--Lunch meeting with Dr Bollenbeck

2:30--Cat ear injury surgery, Finally get to put on tie and doctors jacket!

3-7pm

• Cat paw injury and x-rays
• Tremoring older dog exam
• Neurologic exam on middle aged dog
• Ear recheck-resolved!
• Dental recheck-resolved!
• Senior exam and Mast Cell Tumor treatment plan
• Fill out scaler loaner paperwork and have techs ship out scaler for repair
• Type up Vaccine policy changes for staff meeting
• Approve amlodipine dispense

8pm-type up blog

8:15-8:45 More book on tape

8:45-Spouse and kid time

I love this life.