Addiction XXXXIII
01-08-15, 06:42 PM
#828
Has a magic bike
Join Date: Aug 2013
Location: Los Angeles
Posts: 12,590
Bikes: 2018 Scott Spark, 2015 Fuji Norcom Straight, 2014 BMC GF01, 2013 Trek Madone
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Crazy day.
One of my favorite patients has a technically fatal disease but I have kept him alive and kicking and mostly neurologically normal for 2.5 years now. Lots of scary medications which require lots of micromanaging to have the desired effect without bad side effects. Anyway, he came back in last night with a relapse of his symptoms. He had his 4th lifetime MRI and spinal tap today and, yep, his disease is back. The problem is that I have already given him his max lifetime dose of my most effective medication, I have moved on to a complicated treatment regimen of four other meds and I don't have too much left in my back pocket for this dog. I have come up with a fresh game plan that is sure to work in the short term but hard to know where we will be four months from now. Yes these people are rich BTW. Dad is a big time lawyer. All I can say is thank God for the celebrity screw up.
Then my first appointment was a laterally recumbent 18 year old cat with symptoms relating both to the inner ear and adjacent brainstem. The best thing is could have been is an inner ear infection that has spread to the brain and that is honestly not a very good thing to have, requires a very major surgery, too major IMO for an 18 year old cat. I'm sorry Lady-I-Just-Met-Fifteen-Minutes-Ago, the only realistic option is to euthanize your cat.
Also rechecked my happy-go-lucky 4 year old epileptic pit bull, who was coughing last month and was diagnosed with heart failure. A genetic form of heart failure called dilated cardiomyopathy. Maybe 4-12 months to live, that is some very bad luck. Had two seizures recently, which we really don't want, it will stress the heart further. Reviewing her bloodwork from her heart-failure hospital stay a month ago, I'm worried she may be developing a liver toxicity from one of her seizure medications. Something I can reverse by weaning her off the medication but then the seizures may get stirred up again so I totally hope the liver function test comes back ok.
The a little Chihuahua type dog with excruciating neck pain. Based on xrays, there's a 90% chance the pain is from a disc herniation and there's a 90% chance I can totally fix the dog instantly with surgery, its amazing how usually these dogs wake up from a major spinal surgery and feel so much better, sometimes they can even go home the very next day. But its a young couple, no money to spare on something like this. I have whittled expenses down as absolutely far as I can, and offered them a discount on top of that. They have good credit, just don't know they should go into debt fixing their little dog. The girl was crying and wondering if they should be thinking euthanasia, she can't stand to see the dog in pain. I talked her off that ledge, I hope it does not come to that, I have loaded that dog up with pain meds and anti-inflammatories and muscle relaxants and we are going to see how it goes through the weekend. Maybe we will do surgery next week if the pain doesn't get better.
We did have some really good rechecks- a dog with terrible epilepsy, used to sometimes have 20 seizures in a day, annual recheck exam and he has only had one seizure this whole year. A cat with a muscle disorder, first recheck exam since diagnosis and he is markedly improved on meds, couldn't really walk two weeks ago and now he is running around the house chasing the other cat. Encephalitis recheck doing great.
Interviewed a kind of weird guy for an intern applicant. And two more phone interviews. Plus maybe 6 more email exchanges, it was a busy day. Did get in a nice trainer workout this morning. And I have some nice rides set up for this weekend, sweetness on that.
One of my favorite patients has a technically fatal disease but I have kept him alive and kicking and mostly neurologically normal for 2.5 years now. Lots of scary medications which require lots of micromanaging to have the desired effect without bad side effects. Anyway, he came back in last night with a relapse of his symptoms. He had his 4th lifetime MRI and spinal tap today and, yep, his disease is back. The problem is that I have already given him his max lifetime dose of my most effective medication, I have moved on to a complicated treatment regimen of four other meds and I don't have too much left in my back pocket for this dog. I have come up with a fresh game plan that is sure to work in the short term but hard to know where we will be four months from now. Yes these people are rich BTW. Dad is a big time lawyer. All I can say is thank God for the celebrity screw up.
Then my first appointment was a laterally recumbent 18 year old cat with symptoms relating both to the inner ear and adjacent brainstem. The best thing is could have been is an inner ear infection that has spread to the brain and that is honestly not a very good thing to have, requires a very major surgery, too major IMO for an 18 year old cat. I'm sorry Lady-I-Just-Met-Fifteen-Minutes-Ago, the only realistic option is to euthanize your cat.
Also rechecked my happy-go-lucky 4 year old epileptic pit bull, who was coughing last month and was diagnosed with heart failure. A genetic form of heart failure called dilated cardiomyopathy. Maybe 4-12 months to live, that is some very bad luck. Had two seizures recently, which we really don't want, it will stress the heart further. Reviewing her bloodwork from her heart-failure hospital stay a month ago, I'm worried she may be developing a liver toxicity from one of her seizure medications. Something I can reverse by weaning her off the medication but then the seizures may get stirred up again so I totally hope the liver function test comes back ok.
The a little Chihuahua type dog with excruciating neck pain. Based on xrays, there's a 90% chance the pain is from a disc herniation and there's a 90% chance I can totally fix the dog instantly with surgery, its amazing how usually these dogs wake up from a major spinal surgery and feel so much better, sometimes they can even go home the very next day. But its a young couple, no money to spare on something like this. I have whittled expenses down as absolutely far as I can, and offered them a discount on top of that. They have good credit, just don't know they should go into debt fixing their little dog. The girl was crying and wondering if they should be thinking euthanasia, she can't stand to see the dog in pain. I talked her off that ledge, I hope it does not come to that, I have loaded that dog up with pain meds and anti-inflammatories and muscle relaxants and we are going to see how it goes through the weekend. Maybe we will do surgery next week if the pain doesn't get better.
We did have some really good rechecks- a dog with terrible epilepsy, used to sometimes have 20 seizures in a day, annual recheck exam and he has only had one seizure this whole year. A cat with a muscle disorder, first recheck exam since diagnosis and he is markedly improved on meds, couldn't really walk two weeks ago and now he is running around the house chasing the other cat. Encephalitis recheck doing great.
Interviewed a kind of weird guy for an intern applicant. And two more phone interviews. Plus maybe 6 more email exchanges, it was a busy day. Did get in a nice trainer workout this morning. And I have some nice rides set up for this weekend, sweetness on that.
01-08-15, 08:06 PM
#829
Mostly Harmless
Join Date: Jul 2008
Location: Chittenango, NY
Posts: 56,600
Bikes: Have two wheels
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01-08-15, 08:12 PM
#830
Senior Member
Join Date: Aug 2007
Location: RVA
Posts: 6,404
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Crazy day.
One of my favorite patients has a technically fatal disease but I have kept him alive and kicking and mostly neurologically normal for 2.5 years now. Lots of scary medications which require lots of micromanaging to have the desired effect without bad side effects. Anyway, he came back in last night with a relapse of his symptoms. He had his 4th lifetime MRI and spinal tap today and, yep, his disease is back. The problem is that I have already given him his max lifetime dose of my most effective medication, I have moved on to a complicated treatment regimen of four other meds and I don't have too much left in my back pocket for this dog. I have come up with a fresh game plan that is sure to work in the short term but hard to know where we will be four months from now. Yes these people are rich BTW. Dad is a big time lawyer. All I can say is thank God for the celebrity screw up.
Then my first appointment was a laterally recumbent 18 year old cat with symptoms relating both to the inner ear and adjacent brainstem. The best thing is could have been is an inner ear infection that has spread to the brain and that is honestly not a very good thing to have, requires a very major surgery, too major IMO for an 18 year old cat. I'm sorry Lady-I-Just-Met-Fifteen-Minutes-Ago, the only realistic option is to euthanize your cat.
Also rechecked my happy-go-lucky 4 year old epileptic pit bull, who was coughing last month and was diagnosed with heart failure. A genetic form of heart failure called dilated cardiomyopathy. Maybe 4-12 months to live, that is some very bad luck. Had two seizures recently, which we really don't want, it will stress the heart further. Reviewing her bloodwork from her heart-failure hospital stay a month ago, I'm worried she may be developing a liver toxicity from one of her seizure medications. Something I can reverse by weaning her off the medication but then the seizures may get stirred up again so I totally hope the liver function test comes back ok.
The a little Chihuahua type dog with excruciating neck pain. Based on xrays, there's a 90% chance the pain is from a disc herniation and there's a 90% chance I can totally fix the dog instantly with surgery, its amazing how usually these dogs wake up from a major spinal surgery and feel so much better, sometimes they can even go home the very next day. But its a young couple, no money to spare on something like this. I have whittled expenses down as absolutely far as I can, and offered them a discount on top of that. They have good credit, just don't know they should go into debt fixing their little dog. The girl was crying and wondering if they should be thinking euthanasia, she can't stand to see the dog in pain. I talked her off that ledge, I hope it does not come to that, I have loaded that dog up with pain meds and anti-inflammatories and muscle relaxants and we are going to see how it goes through the weekend. Maybe we will do surgery next week if the pain doesn't get better.
We did have some really good rechecks- a dog with terrible epilepsy, used to sometimes have 20 seizures in a day, annual recheck exam and he has only had one seizure this whole year. A cat with a muscle disorder, first recheck exam since diagnosis and he is markedly improved on meds, couldn't really walk two weeks ago and now he is running around the house chasing the other cat. Encephalitis recheck doing great.
Interviewed a kind of weird guy for an intern applicant. And two more phone interviews. Plus maybe 6 more email exchanges, it was a busy day. Did get in a nice trainer workout this morning. And I have some nice rides set up for this weekend, sweetness on that.
One of my favorite patients has a technically fatal disease but I have kept him alive and kicking and mostly neurologically normal for 2.5 years now. Lots of scary medications which require lots of micromanaging to have the desired effect without bad side effects. Anyway, he came back in last night with a relapse of his symptoms. He had his 4th lifetime MRI and spinal tap today and, yep, his disease is back. The problem is that I have already given him his max lifetime dose of my most effective medication, I have moved on to a complicated treatment regimen of four other meds and I don't have too much left in my back pocket for this dog. I have come up with a fresh game plan that is sure to work in the short term but hard to know where we will be four months from now. Yes these people are rich BTW. Dad is a big time lawyer. All I can say is thank God for the celebrity screw up.
Then my first appointment was a laterally recumbent 18 year old cat with symptoms relating both to the inner ear and adjacent brainstem. The best thing is could have been is an inner ear infection that has spread to the brain and that is honestly not a very good thing to have, requires a very major surgery, too major IMO for an 18 year old cat. I'm sorry Lady-I-Just-Met-Fifteen-Minutes-Ago, the only realistic option is to euthanize your cat.
Also rechecked my happy-go-lucky 4 year old epileptic pit bull, who was coughing last month and was diagnosed with heart failure. A genetic form of heart failure called dilated cardiomyopathy. Maybe 4-12 months to live, that is some very bad luck. Had two seizures recently, which we really don't want, it will stress the heart further. Reviewing her bloodwork from her heart-failure hospital stay a month ago, I'm worried she may be developing a liver toxicity from one of her seizure medications. Something I can reverse by weaning her off the medication but then the seizures may get stirred up again so I totally hope the liver function test comes back ok.
The a little Chihuahua type dog with excruciating neck pain. Based on xrays, there's a 90% chance the pain is from a disc herniation and there's a 90% chance I can totally fix the dog instantly with surgery, its amazing how usually these dogs wake up from a major spinal surgery and feel so much better, sometimes they can even go home the very next day. But its a young couple, no money to spare on something like this. I have whittled expenses down as absolutely far as I can, and offered them a discount on top of that. They have good credit, just don't know they should go into debt fixing their little dog. The girl was crying and wondering if they should be thinking euthanasia, she can't stand to see the dog in pain. I talked her off that ledge, I hope it does not come to that, I have loaded that dog up with pain meds and anti-inflammatories and muscle relaxants and we are going to see how it goes through the weekend. Maybe we will do surgery next week if the pain doesn't get better.
We did have some really good rechecks- a dog with terrible epilepsy, used to sometimes have 20 seizures in a day, annual recheck exam and he has only had one seizure this whole year. A cat with a muscle disorder, first recheck exam since diagnosis and he is markedly improved on meds, couldn't really walk two weeks ago and now he is running around the house chasing the other cat. Encephalitis recheck doing great.
Interviewed a kind of weird guy for an intern applicant. And two more phone interviews. Plus maybe 6 more email exchanges, it was a busy day. Did get in a nice trainer workout this morning. And I have some nice rides set up for this weekend, sweetness on that.
Keep up the good work ....
01-08-15, 08:16 PM
#831
Super Modest
Join Date: Jun 2002
Location: Central Illinois
Posts: 23,467
Bikes: Trek Emonda, Giant Propel, Colnago V3, Co-Motion Supremo, ICE VTX WC
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01-08-15, 08:16 PM
#832
Should Be More Popular
Join Date: Dec 2007
Location: Malvern, PA (20 miles West of Philly)
Posts: 43,057
Bikes: 1986 Alpine (steel road bike), 2009 Ti Habenero, 2013 Specialized Roubaix
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01-08-15, 08:17 PM
#833
Still can't climb
Join Date: Sep 2006
Location: Limey in Taiwan
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if i were a vet i would be in mourning all the time. i couldn't handle so many deaths. most people get so upset when their pet dies. imagine getting that every week or so.
__________________
coasting, few quotes are worthy of him, and of those, even fewer printable in a family forum......quote 3alarmer
No @coasting, you should stay 100% as you are right now, don't change a thing....quote Heathpack
coasting, few quotes are worthy of him, and of those, even fewer printable in a family forum......quote 3alarmer
No @coasting, you should stay 100% as you are right now, don't change a thing....quote Heathpack
01-08-15, 08:19 PM
#834
Still can't climb
Join Date: Sep 2006
Location: Limey in Taiwan
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__________________
coasting, few quotes are worthy of him, and of those, even fewer printable in a family forum......quote 3alarmer
No @coasting, you should stay 100% as you are right now, don't change a thing....quote Heathpack
coasting, few quotes are worthy of him, and of those, even fewer printable in a family forum......quote 3alarmer
No @coasting, you should stay 100% as you are right now, don't change a thing....quote Heathpack
01-08-15, 08:22 PM
#835
Senior Member
Join Date: Aug 2007
Location: RVA
Posts: 6,404
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Totally agree...I'm guessing it's balanced out by the realization that death is part of the deal but the good part of the job is helping heal so many others and giving those owners and there furry buddies a little more time to enjoy each others company....
01-08-15, 08:22 PM
#836
Mostly Harmless
Join Date: Jul 2008
Location: Chittenango, NY
Posts: 56,600
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01-08-15, 08:25 PM
#838
Still can't climb
Join Date: Sep 2006
Location: Limey in Taiwan
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__________________
coasting, few quotes are worthy of him, and of those, even fewer printable in a family forum......quote 3alarmer
No @coasting, you should stay 100% as you are right now, don't change a thing....quote Heathpack
coasting, few quotes are worthy of him, and of those, even fewer printable in a family forum......quote 3alarmer
No @coasting, you should stay 100% as you are right now, don't change a thing....quote Heathpack
01-08-15, 08:28 PM
#839
Administrator
Thread Starter
Join Date: Apr 2005
Location: Hudson Valley, NY
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__________________
See, this is why we can't have nice things. - - smarkinson
Where else but the internet can a bunch of cyclists go and be the tough guy? - - jdon
01-08-15, 08:30 PM
#840
Has a magic bike
Join Date: Aug 2013
Location: Los Angeles
Posts: 12,590
Bikes: 2018 Scott Spark, 2015 Fuji Norcom Straight, 2014 BMC GF01, 2013 Trek Madone
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I would go broke in your business. I couldn't stand to see a dog suffer if I could fix him...and yes the owners should go in debt for thier little doggie...they have there friends and so on and so forth....all he has is them! Hoping for the best!
Keep up the good work ....
Keep up the good work ....
I'll do everything I can to get the little dog fixed but will pass no judgement whatever decision these people make. They love the dog and will do the best they can for him, I'm pretty confident about that.
01-08-15, 08:31 PM
#841
Administrator
Thread Starter
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+1 He's thinking "I wish I was a big dog, for just one day, so I could bite this dumbass."
__________________
See, this is why we can't have nice things. - - smarkinson
Where else but the internet can a bunch of cyclists go and be the tough guy? - - jdon
01-08-15, 08:32 PM
#842
Stand and Deliver
Join Date: Jun 2008
Location: Tampa Bay
Posts: 3,340
Bikes: Cannondale R1000, Giant TCR Advanced, Giant TCR Advanced SL
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You won't be too far from Clermont, FL. If you're not already aware, there's some nice elevation in some areas northeast of Lake Minneola --- Sugarloaf, Buckhill rd, etc. If you get over toward the Dade City, Brooksville or Tampa area, give me a shout.
Last edited by FLvector; 01-08-15 at 08:36 PM.
01-08-15, 08:42 PM
#844
Still can't climb
Join Date: Sep 2006
Location: Limey in Taiwan
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civil servants.
my mistake...civil overlords.
my mistake...civil overlords.
__________________
coasting, few quotes are worthy of him, and of those, even fewer printable in a family forum......quote 3alarmer
No @coasting, you should stay 100% as you are right now, don't change a thing....quote Heathpack
coasting, few quotes are worthy of him, and of those, even fewer printable in a family forum......quote 3alarmer
No @coasting, you should stay 100% as you are right now, don't change a thing....quote Heathpack
01-08-15, 08:45 PM
#845
Still can't climb
Join Date: Sep 2006
Location: Limey in Taiwan
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don't get me going on civil servants.
I'll go start a P&R thread ranting against civil servants.
I'll go start a P&R thread ranting against civil servants.
__________________
coasting, few quotes are worthy of him, and of those, even fewer printable in a family forum......quote 3alarmer
No @coasting, you should stay 100% as you are right now, don't change a thing....quote Heathpack
coasting, few quotes are worthy of him, and of those, even fewer printable in a family forum......quote 3alarmer
No @coasting, you should stay 100% as you are right now, don't change a thing....quote Heathpack
01-08-15, 08:58 PM
#848
Still can't climb
Join Date: Sep 2006
Location: Limey in Taiwan
Posts: 23,024
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i went to the tax office yeserday.
__________________
coasting, few quotes are worthy of him, and of those, even fewer printable in a family forum......quote 3alarmer
No @coasting, you should stay 100% as you are right now, don't change a thing....quote Heathpack
coasting, few quotes are worthy of him, and of those, even fewer printable in a family forum......quote 3alarmer
No @coasting, you should stay 100% as you are right now, don't change a thing....quote Heathpack
01-08-15, 09:02 PM
#849
Mostly Harmless
Join Date: Jul 2008
Location: Chittenango, NY
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01-08-15, 09:05 PM
#850
Still can't climb
Join Date: Sep 2006
Location: Limey in Taiwan
Posts: 23,024
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__________________
coasting, few quotes are worthy of him, and of those, even fewer printable in a family forum......quote 3alarmer
No @coasting, you should stay 100% as you are right now, don't change a thing....quote Heathpack
coasting, few quotes are worthy of him, and of those, even fewer printable in a family forum......quote 3alarmer
No @coasting, you should stay 100% as you are right now, don't change a thing....quote Heathpack