Judgement Call #2 - I am not always right

It recently occurred to me that I have been talking up my success stories at work, but I haven't said much about my missteps. And there are plenty. Thankfully they are becoming less frequent the longer I am in the profession (as the saying goes, you learn something every day), but they happen nonetheless. I was reminded of that today, when I made a judgement call that didn't work out as hoped.

At about 10 am I saw a 2 year old male cat who couldn't pee. This is a surprisingly common occurance and I see about one of these guys every month or two. This problem is usually caused by plug of crystals and mucus that forms in the bladder and gets lodged in the urethra on the way out. If left untreated, the cat's kidneys will shut down and it will die within a couple of days. So emergency intervention is needed.

The standard protocol for these guys is to stabilize them if possible (and if needed) with IV fluids and treatement if their electrolytes are out of whack. Then you sedate the cat and attempt to pass a catheter into the urethra (starting at the tip of the penis) to he bladder. Usually you have to push or flush the plug into the bladder in order to relieve the obstruction. In the past, it was recommended to sew the catheter in for a couple of days in order to allow the bladder to heal from being stretched and the swelling in the urethra to go down. However, sewing the catheter in can be a pain. It can become kinked or clogged, the cat has to wear the cone of shame 24/7 in order to keep him from pulling the cath out, and it is a good way to introduce a urinary tract infection. So I believe that we are sewing in fewer catheters these days. Well, at least I am. I have had some pretty good success relieving the obstruction with a catheter but not keeping it in.

Anyway, this cat was difficult to catheterize and I cause quite a bit of swelling "down there" as I forced saline into his urethra to relieve the obstruction. However, once the obstruction was gone, he had a great stream of urine and the catheter passed super easy. I flushed his bladder several times and each time I pressed on it after filling it with saline, a nice stream of saline/urine came out.

So, time for another judgement call. Leave the cath in? Take it out? I decided to take it out and see if he was able to pee on his own. Every couple of hours I checked on him. No urine in the litter box (and he was on a high rate of IV fluids at this point). I could not express any urine when I pressed on his bladder. This dance continued until I left the office at 4:30 pm, knowing that I would have to come back later because he wasn't going to pee. Stupid cat.

Sure enough, when I came back (after running my kids all over town to their activities), there was still no urine and I still couldn't express his bladder. So I sedated him AGAIN and tried to express urine - no luck there. Couldn't blame it on urethral spasms at this point. He must have re-obstructed. So I passed a catheter AGAIN, but there was only a little bit of resistance until I was able to push through the obstruction. Again it became easy to catheterize him, but he didn't have quite as good a urine stream when I expressed his bladder. I guess I had to sew in the cath at this point.

Sometimes I'll take these guys home with me for the night and let them hang out in my bathtub so that I can check on them. But tonight I had to go straight to a meeting and couldn't leave him in the car. So he's at the clinic and I have to hope that he behaves and doesn't pull his catheter out, and that that catheter behaves and doesn't get clogged or kinked in the next 12 hours. Because if any of the these happen, it can further stratch and damage his bladder and we will probably have to start all over again.

And you wonder why I take Xanax every night to get to sleep?

The dog from last Saturday is doing great!

That's all I have to say right now. Merry Christmas!

Judgement Call

I am not a surgeon. I am not a radiologist. I am not an internist. I am a general practitioner, which means that, for better or worse, I know a little about a lot. This can sometimes get me into uncomfortable situations.

Last Friday a patient of mine came in for vomiting. The poor dog was vomiting large volumes of bright yellow fluid several times an hour, and had been doing so (off and on) for about a day. Other than him being a little dehydrated, I couldn't find anything wrong when I examined him. His belly didn't even hurt. I admitted him to the hospital for some diagnostic testing and IV fluids. His abdominal x-rays showed a very distended stomach - filled with some gas and a lot of liquid. I didn't see any foreign object or other evidence of obstruction, although the dog did have a tendancy to "eat anything and everything". His labwork was normal. I got a couple of second opinions (I took a digital photograph of the x-rays and texted them to Lisa, and also a friend of mine, who is a veterinary internist, was at my clinic with her kitten and I showed them to her as well). Well, you do what you have to when you're in general pactice by yourself! There was no consensus on whether the dog had an obstruction, so I elected to re-take the x-rays in a few hours. That led to a contrast dye study of his GI tract at 6 pm Friday. The dye started to leave his stomach pretty quickly, but then it kind of just petered out. But not in the typical "gee there's something stuck in your gut" pattern. It could be an obstruction. Or maybe just ileus, where the GI tract just decides not to move things through.

Hmmm... Now what? The dog was looking better and hadn't vomited in a few hours, so I sent him home with instructions to bring him back the next morning for a follow-up x-ray. The owner came in at 10:45 am as instructed. The dog had done great all night, but vomited a little just before coming to the clinic. I took an x-ray and it looked exactly the same as the last one we had taken the night before. The stomach was still filled with barium (the dye that we used). Crap.

At least it was now a no-brainer. I make some quick mental calculations. It was 11 am. I needed to be at a doctor's appointment 15 miles away at 1 pm. Could my two techinicians and I prep, anesthetize, operate, and recover the dog in 90 minutes? Of course I offered to just send the dog to an emergency clinic (E clinic) for the surgery, but the owner really trusted us and wanted us to do it. And it was sort of a win-win for both parties. Our surgery fees are much less than an E clinic's fees. And in the slow winter months, my clinic could really use the added income that an emergency surgery brings. I figured it would be a quick incision into the stomach to remove the offending object, then wake him up and send him to the E clinic for post-op care.

Well, you know I wouldn't be writing about this if it was that simple, right? First, when I had one of my techs pass a stomach tube in order to empty the stomach of all of that barium, most of the stomach contents (ie barium and bile) started to come out if his mouth rather than the stomach tube, putting him at risk for aspirating the liquid. As you probably don't know, barium in the lungs is a very bad thing. However, the dog was anesthetized and had a tracheal tube in place, which hopefully would keep the liquid from entering his airways.

THEN, the damned foreign body wasn't in his stomach after all, but his small intestine! A more difficult surgery, but also one that gave me a dilemma. The piece of plastic or whatever it was (the owner couldn't figure it out when we showed it to her either) was probably sitting happily in his stomach for quite some time, But then it decided to make its way into his duodenum, which had to stretch in order to accomodate said object. The 10 or so inches of intestine that the plastic has thus far passed through was very dilated and had a red/purple/black splotchy color. It was angry. But was it damaged beyond repair?

That is the million dollar question. That is when I wish I was a surgical specialist who has done hundreds of these surgeries, rather than a GP who does maybe one or two intestinal surgeries a year. Then I would maybe know if it was ok to leave the mad intestines in, or if they required surgical removal (intestinal resection and anastomosis). Guessing wrong could have dire consequences. Three years ago, almost to the day, I did a FB surgery on a dog who had decided to eat her blanket. I removed the blanket pieces, but not any intestine. Her whole small intestinal tract was damaged, and I really didn't want to remove all of it (because as you can imagine, that would also cause problems), so not knowing what parts would be ok and what wouldn't, I left it all in. And crossed my fingers that it would all be work out. In this case, it didn't. The next day her intestines started to leak in 3 areas, requiring a second surgery. But because she was now septic, she couldn't heal well, so I sent her to the U of M for a 3rd surgery, which she did not recover from. She died on Christmas Eve.

So fast forward back to Saturday. I'm stadning there with an open abdomen and a decision needs to be made. Leaving the damaged intestine in would be quicker (selfishly allowing me to make it to my own appointment on time). Taking it out would be safer. Well, sort of. Because the part that I would have to remove would be the most difficult portion of the GI tract to do surgery on. It is adhered to the abdominal wall near the spine by a large ligament, making it difficult to isolate and operate on. There is also the pancreas that empties into that part of the intestines, and you really don't want to mess with the pancreas. Because I am not a surgeon, the only other time I attempted surgical removal of that part of the GI tract was the second surgery in the dog I just described. And we know how that went.

So I left it in.

And called the E clinic 3 times in the next 24 hours to get an update. Did he have aspiration pneumonia from the barium? Did he have a septic abdomen from a leaking gut? When could I sleep at night knowing that he was finally out of the woods??

Today is Monday, 48 hours after surgery. The dog was doing great yesterday and was discharged from the E clinic. He was doing great at home today. I figure one more day and I can breathe a sigh of relief. I would hate to have to re-visit the Christmas of 2008 again.

I'll let you know tomorrow.

Yes, the freaking lump is still there. So what?

Cancer can make you crazy. I think anybody's that been touched by the disease in any way would probably agree. Even my most sane-appearing cancer-survivor friends have moments of temporary insanity. And although it diminishes, the fear never really leaves. If you've had a relative die of cancer, you know you're genetically marked and could develop the same disease at any time. If you yourself have had cancer, or are considered high-risk, you're always on the watch for it to rear its ugly head again.

How has it affected me? Well, 99% of the time, it hasn't. I go about my life as always. I had my nervous breakdown last spring and I'm over that part. But, as you know, I am vigilant now, so I started doing breast self-exams and exactly 16 days ago (not that I'm counting) I felt a lump. I didn't panic at first, but I did end up going to not one, but two doctors in the next week or so. Both told me not to worry but to recheck in 6-8 weeks. So at first I didn't worry. But then I noticed that the lump was changing, and it certainly wasn't going away. It was more firm and starting to be a little painful. Is that a good sign? Statistically, yes. Pain is usually associated with benign conditions. But 11% of breast cancer presents itself with a painful mass.

So last week I called my surgeon. The tone of her voice was just a little on the annoyed side, as I'm sure she gets phone calls like this a lot. No, Jami. It is not going to hurt to wait the 6 weeks to have it checked again. Studies have shown that. Coming in sooner will not help, and may result in an unnecessary biopsy.

My poor primary physician. He is married to a friend of mine (and fellow veterinarian). Because I've become a little crazy, I've been having conversations with his wife that go like this: Can I come over to you house and I'll even bring beer and your husband (and even you if you want, since the more opinions the better) can feel me up again? Or (from her), how about I bring our kitten into your clinic for vaccines and I'll bring my husband and he can check you in your office?

Isn't that a little nuts?

The irony is not lost on me. Last spring all of my tests were doctor-driven. I was in a state of shock for much of the time and just let them lead me from one procedure to next. I didn't have a lump or any symptoms, so the whole thing was a bit surreal. I almost didn't believe it was happening. This time around, I found a lump, a tangible sign that all is not right. Because it sort of hurts, I am reminded of it often, even if I've stopped obsessively checking it out. I am the one wanting to be more aggressive. Heck, if the surgeon told me she wanted to take it out, at this point I'd jump right into the operating room. Yes! Take it out! Do SOMETHING!

However, I am actually in a much better state of mind this week than last. I can be patient (although it is not one of my stronger suits). I can wait the 34 days until my next doctor appointment. I can do this. I am not crazy. For now.

Appointments 17 and 18 - Was that a lump I felt?

OK, let's review here a little. First mammogram ever was done last February. Found an abnormality, which led to more mammograms and biopsies and an MRI and surgery and a teeny mental breakdown when I went from being told I had cancer to being told I probably didn't. Started the evil drug tamoxifen, but stopped it after it made me crazy.

So, now that I'm a high-risk patient, I thought I should start doing breast self-exams. But I didn't start right away. I can't really describe it, but I was angry for awhile. Angry at the situation and angry at my breasts for betraying me. So I ignored them. Finally, in the middle of the summer, I decided to end the breast silent treatment and start doing self exams.

*** Please note: The following text contains descriptions of BREASTS and other WOMANLY STUFF and may not be appropriate for the squeamish!***

So, every week or so, when lathered up in the shower, I would check them out. And just like the book says, they do change based on where I am in my menstrual cycle. So it was good to do the exams every week, so I could follow the normal hormonally-caused changes. I'd done maybe 20 or so self exams and they were all normal. A week ago last Sunday, however, I lathered up and palpated my boobs like always except this time... hmmm... there was a weird knot thing in my lower lateral left breast (not the one where I had surgery, BTW). It was the size of my finger tip and blipped in and out of my fingers. Stay calm, I told myself. You are due for your period any day now and the glandular tissue tends to get larger and more firm at about this time. But I had Lisa feel it too (well, you're the one who decided to keep reading!) and she concurred that it did not feel like the rest of my breast tissue.

So the next day I left a message for my primary doctor, who called back and said if I were his wife he would want me to get in right away. Before he called back, I also spoke with a nurse at the Piper Breast Center, who told me to wait 1-2 weeks and have my surgeon check it out.

Well, I decided to go in earlier to see my primary doc three days after I initially felt the weird lump. It was a frustrating visit because I (like always) had to wait almost an hour to be seen. Grrr.... AND neither of us could feel it! But it was just there this morning! WTF??? Well, he said, I don't want to you to be worried about it, so we can schedule an ultrasound just to be sure. Nah, I said. I'll wait and see what happens after my period is over.

Well, a couple of days later it was still there, so I went ahead and made an appointment with the breast surgeon. The timing was good - 8 days after the start of my menstrual cycle, when the breasts are the least tender and lumpy. But because of the false alarm I had at the first appointment, I became a little obsessed about this lump. Every day
I checked it in the morning (always there). I checked it at noon (sometimes not there). I checked it at night (always there). I even checked it several times while driving the car - well it's not like anyone can see that you have your hand up your shirt when you're driving! Right?? I would say that I felt the lump about 80% of the time, and it didn't seem to be getting any smaller. I wish I could have had some of my friends check it for confirmation, but I suppose that crosses a line.  I could have had Lisa feel it a couple of times, but I also didn't want to bring it up a lot and worry her. Even though I was afraid of cancer, I was more afraid that the doc wouldn't be able to find the lump and then I would really think I had lost my mind.

So I had the appointment with the surgeon this morning. Checked the lump in the shower. There. Checked it in the car. There. Got to the doctor's office and they took me right in. (See? That's how a doctor's office should run!) Disrobed the upper half and checked again. Still there. The surgeon came in minutes, yes MINUTES later and did a pretty thorough exam and couldn't feel anything. DAMMIT! So I tried to point it out to her and I started to panic - I couldn't find it either! Aaack! I really am insane!! But I calmed myself down, took a deep breath, and finally located the lump. THANK GOD. Yes, I was actually thankful for finding a breast lump. That's what I've come to.

She told me it felt like a ridge of glandular tissue, so it was likely nothing to be worried about. But we could order an ultrasound... What do you think, I asked? After pondering for a second, she said she'd call downstairs and see if they could get me in right now for an ultrasound. Yes, they could get me in right away. This place was not the Piper Center; it was the place where I had my failed stereotactic biopsy attempt. But my surgeon assured me that they would be perfectly capable of doing an ultrasound. OK. She also told me that if the ultrasound was normal she wanted to see me back in 6 weeks and if it got any bigger, we'd just take it out. What? I wasn't sure I heard her right. You know, remove it, she replied. Of course. Once a surgeon, always a surgeon. Should I have expected anything different from her?

The ultrasound was pretty uneventful. It was noted (as always) that I have very dense breasts (a trait for which I am extremely proud), but no discernable mass. Whew.

Looking back, here are the stats:
9 months
18 appointments
7 mammograms
6 clinical breast exams

And guess what? We're not done yet.

No good deed goes unpunished

"Ruby" (not her real name) was a 5 year old cute little lab mix who came in last month for a 2 month history of vaginal discharge and increasing lethargy. My associate vet saw her and after a few tests she diagnosed Ruby with a pyometra, which is a fairly common disease in unspayed female dogs. What happens is that the reproductive hormones get sort of out of whack and bacteria get involved and the uterus fills with pus. The infection can make the dog quite sick, as every organ in the body can become affected in some way or another. The treatment of choice is stabilization (if the animal is critically ill) and then an emergency spay. However, this is no ordinary spay - removing a fragile, pus-filled uterus can be challenging.

In Ruby's case, she was very anemic. We suspect that her immune system was fighitng off the infection for so long that it started to attack her red blood cells as well. Additionally, she may also have lost some blood through the chronic discharge from her uterus. At any rate, I strongly recommended referring her to a speciality clinic for a blood transfusion, as I didn't think she would survive surgery without it. The owners thought long and hard, but in the end they decided that they couldn't afford the $2000+ bill and they told me to euthanize her.

Damn. Another one of those moments where I have to make a decision. Another moment when someone else's problem becomes mine. Don't get me wrong, I have euthanized many animals for financial reasons, but some just make you think about giving them a second chance. Ruby was one of them. She was young and sweet and had a potentially curable problem.

So... I called the owner back and asked if she would be willing to sign Ruby over to us and we would attempt to fix her and find her a new home. The owner was pleasantly surprised and jumped at the chance to give her dog another chance. Because I was essentially footing the bill at this point, I did the surgery without a pre-op transfusion. It was a little nerve-wracking, since every drop of blood lost was bringing her that much closer to death. But the surgery was a success. So successful, in fact, that by the next day Ruby's red blood cell count had gone up 10 points (removing the infection likely turned her off over-active immune system and allowed her red blood cells to regenerate).

I was very pleased at the result. Happy me, happy dog. A few days later I mentioned her to my minister, Kent, whom I knew to be kind of looking for a dog. His wife wasn't 100% sold on the idea but one thing led to another, and within hours they met me at the vet clinic to meet Ruby. Ruby was a little shy, but everything seemed to be going well. After thinking about it over the weekend, they decided to take her home on Monday for a trial week. I met Kent at the clinic and my staff got everything arranged - dog food, bed, toys, kennel. They put it all in his car, put Ruby in the passenger seat, and Kent buckled his two small children in the back seat and they were ready to go. I just knew it was going to work. I said good-bye and went back into my office. Not 30 seconds later, one of my staff ran in, saying that Ruby had bit Kent and there was blood everywhere. WHAT??

I ran outside to find a bleeding Kent and two crying kids. Ruby had already been removed from the scene. It sounds like Ruby attacked Kent out of fear after he he tried to move her foot. She bit him 4-5 times in the hands, broke his watch, and set him to urgent care for 14 (I believe) stitches.

I was mortified. I had no idea that Ruby would bite, let alone attack (although I am convinced that it was out of fear rather than aggression). I felt terrible. However Kent and even his not 100% dog-loving wife were great. My liability insurance covered his medical bils, but hopefully he (and his poor kids!) won't be too scarred from this.

So what happened to Ruby? Well, I had another decision to make. I couldn't adopt her out, because I now know that she could bite. I certainly didn't want that liability. I could euthanize her. Or....

I called her previous owners, told them the entire story, and said that if they wanted Ruby back, they could have her. I made it clear that I have never done this before and likely would never do it again (fix an animal for free and give it back to the original owners, that is). But this was a special case and I really didn't want to put her to sleep after all that I had done. They were shocked (especially about the biting part) but called back the next day and said, yes, they would love to take her back and thank you thank you thank you.

In cases like these, it's easy to be an Monday morning quarteback and try to determine where things went wrong. But you know, sometimes things just happen, and it's not anyone's fault. At least Ruby is back at home, my minister has no hard feelings (ironically, the very next Sunday was the annual Blessing of the Animals and he had to bless dozens of dogs!), and I don't think my liability insurance rates will go up. Ruby's care and surgery, of course, did cost me some time and money, but that's just part of being in this profession. I sometimes have the opportunity to make a real difference. For better, and for worse.

The post-marathon high. And low.

I admit, I do get a runner's high. It took awhile (like a couple of years) to get to that point. You know, where I stopped hating running and started actually enjoying its benefits. So if you hate running, just hang in there! You too will become addicted! Whenever Lisa is crabby and she hasn't run in awhile, I send her out to run. She always comes back in a much better mood. It's so easy, so predictable. We runners are simple that way.

The high I normally get from a run lasts a few hours. Maybe a whole day, if the run went really well. The high I got off of the marathon, however, lasted 2 days. Which sort of makes sense, given how many hours I ran. I figure about one day of feeling good per 2 hours ran, right? I wasn't right physically for the entire week - I couldn't walk, my GI tract was off, and I was fatigued. But I still felt great! I was in a jolly good mood! Until about Wednesday - when I crashed big time. I admit, I was a little depressed for the rest of the week. The only thing that made me happy, believe it or not, was planning my next marathon. I know! I want to run another one! This after telling everyone it was the worst experience of my life!

Runners are crazy. Now I know. Sadly, I have joined the madhouse.

The thing about the marathon is, as I learned the hard way, it's a MARATHON. Everything you think you know about running can just go out the window. You are not the same runner at mile 18 as you were at mile 6. Not by a long shot. So my first marathon was really just a learning experience. Now that I know a little what to expect, I can plan a little better for the next time. Actually, a friend told me the first 4 marathons are like that, but I'm going to be more optimistic. What will I do differently? Well, I won't go out like gangbusters for one thing. In fact, I think I'm going to use Jeff Galloway's run-walk method. Yes, you can complete a marathon in a pretty fast time by walking for a minute every mile. That gives your legs a much-need break so that you can do the run part even faster and for longer. I will also carb load for an entire week before the marathon, not just the night before. Turns out your muscles need lots and lots of glycogen for energy and they run out of glycogen at about mile 18 (which is why so many people hit "the wall" at that point). By carb loading for a week, you can store a lot more glycogen (and water). How do I know this? I read it an article in Runner's World magazine, which came out AFTER I ran the marathon. Oh well. Since I thought I knew every thing I needed to know, I probably wouldn't have read it beforehand anyway.

I'm not sure my friend Margaret is going to run another marathon in the near future, but she sure is acting like it. I see her out on the trail all the time! I, being over 40, needed a week to recover. My first post-marathon run (5 days later) was less than 3 miles at an 11 minute mile pace, and it about killed me. See, now I know my limitations! I'm learning! I plan on doing a half marathon in May, then maybe another fall marathon a year from now.

But for now, I'm enjoying NOT training for anything. I can exercise for the fun of it and it's a nice break. Lisa and I are going to New York this weekend and I can't wait to run in Central Park. At whatever pace and whatever distance we feel like. Because for at least a little awhile I won't have a running agenda.

Kitty 1997(?) - 2011

Kitty, or Black Kitty (as she was known by the kids) came into our lives when I worked at an animal hospital in Warwick, Rhode Island. Someone found her by the road and brought her to the clinic; she was a young adult and seemed perfectly healthy. I spayed her on the sly and brought her back to the apartment I shared with Lisa until the incision healed and her fur grew back. Or at least that's what I told Lisa. I had no intention of bringing her back to work.

We struggled with a name, but did actually gave her one - Lexus. But it never stuck and she's been called Kitty pretty much since day one. Kitty was aloof, intent on being outdoors whenever possible, and an amazing hunter. She routinely brought us dead mice and would howl outside our window in triumph with her catch. One time she ran outside and returned in 30 seconds with a dead baby bunny. Wow!

She would allow us to pet her only on her terms. If you didn't do it right, or pet her for too long, she would give you a little bite and then leap off your lap. We always felt privileged when she allowed our love and affection (which wasn't often). In fact, she remained so hidden that many of our friends didn't even know we had her. Although she spent much of the warmer months outdoors, in the winter she would sleep on Jalen's bed. But only if the conditions were right - move too quickly and she would jump off and disappear, much to Jalen's dismay.

Kitty disappeared about 2 weeks ago. Normally she would grace us with her presence every other day or so, but as the days went on we became more worried. We looked around the neighborhood but knew it would be almost impossible to find her. This morning, however, a neighbor found her in their yard. She was weak, thin, and had trouble breathing. Lisa rushed her to the U of MN and we discovered that she had a large tumor in her lungs. After some deliberation, and especially because her condition didn't improve even with removal of some of the fluid in her chest, we elected to euthanize Kitty.

The kids were devastated. The girls wrote her books that said, We love you so so so so so much. And, I hope you don't go to sleep, because I would be so sad. And they drew a picture of her favorite hiding space - under Jalen's bed. There was much hysteria in the vet hospital visitor's room tonight.

I know this is a lot to write about a cat, but I don't think people knew her very well and I just wanted to share her story. Kitty, we will miss you.

The marathon kicked my ass. But I kicked back a little.

The morning was crisp and cool, with no wind. Perfect marathon conditions. If you're going to get a personal record, this is the weather to do it in, said the newscaster last night. I was prepared. I had divided up my energy gels, I had a supply of Advil in a little plastic bag. I ate a small breakfast of pudding (because it's proven to be gentle on my gut when doing long runs). I even showered before the race. Bring on the marathon.

On the drive to the Metrodome, Margaret and I talked race strategy. I wanted to go out strong, maybe at a 9 minute/mile pace. That would allow us to bank some time for later, or even get a 4 hour time. Not a good idea, said her husband Chad, a 47! time marathoner. You'll get too tired and won't have enough in the tank for the last half. It's a marathon, you know. Whatever, I replied. We'll go out as fast as we feel is comfortable and deal with the later miles, well, later.

The first few miles were awesome. It was cool, the crowds were wild and inspiring, and I felt great. We were going at about 9:30 minute miles, which Margaret thought was too fast. So I would stop for a potty break and she would go on ahead, and then I would sprint to catch up with her. That worked fine until about mile 11 or so. I could feel my legs getting tired. And my feet hurt. And my IT band was starting to act up. Our pace slowed a little, but I still tried to keep it under 10 minute miles.

I lost Margaret for good somewhere before mile 16, I think. There was a huge part of the run that was kind of a blur to me. You see, Chad was right. A marathon is a lot, I mean A LOT longer than a half marathon, or even the 18 miler (my longest run EVER) 3 weeks ago. I didn't hit a wall, but rather a 7 mile stretch of quicksand. My legs felt like lead and I just couldn't will them to move fast enough. Plus, miles 19-23 were all uphill. Some steep hills interspersed with long stretches of less-steep, but still formidable, inclines. At mile 19 I saw my family for the 3rd (I think) time and I switched out of my minimalist shoes, hoping to alleviate some of the foot pain. Lisa told me I was shaking.

At this point I started to walk through the water stops, trying to get some energy back into my legs. I ran into another friend, Alison, who was having troubles of her own; hers relating more to her GI tract. Actually, I noticed that the whole field of runners was starting to fall apart. People were starting to walk, stopping to stretch at the side of the road, and losing their running form. We didn't belong out here. We're not marathoners! We're more like weekend warriors, maybe getting in one long run a week, and that long run isn't nearly long enough. We're old, not built for running, crunched for time, and battling myriad running injuries.Or at least that's my story. But I suspect many fellow runners are in the same boat.

But we forge on.

The crowds were incredible; the only reason I was able to finish, actually. There was shouting, high-fives, offers of candy, music, dancing. It was a party! But one I wanted desperately to end. And my friend Phil was a trooper by spending the better part of his day tracking Margaret and me down so that he could offer words of encouragement at various parts of the run. I finally saw the light at mile 25. Almost there! And finally a downhill! I reached the top of John Ireland Boulevard by the St. Paul Cathedral and the crowds were crazy! Two of my friends had drove in from outer suburbia just to see me finish. I high-fived them, and then my family, and then gave a big whoop to the crowd as I sprinted downhill to the finish. My official time was 4:42:29, with an average pace of 10:47.

I got a medal and a finisher shirt. I can proudly say that I am one of less than 0.1% of the U.S population that has completed a marathon. Right after the race, I was prety adament about it being my first AND last marathon. But even though I did the best I could, I have a nagging feeling that I could have done better. So now, only a few short hours later, and with my knees on ice because I can hardly walk, I am dreaming of a better race in the future... maybe.

Another good day!

It seems like my really feel-good days revolve around running events. Today was the Twin Cities Marathon Weekend 5k-10k-1 mile events. Lisa accidentally forgot to register for the 10 mile, which is to be held tomorrow, so she had to run the 10K today instead. So you could say she overtrained for the 10K, which resulted in a really good run for her. It would have been better had she not felt compelled to stay with her friend who hurt her foot a couple of miles before the end. Nonsense, I told Lisa after the race. I would have left my friend in a heartbeat. In fact I even warned my marathon buddy Margaret of this - I would try not to step on her if she fell, but that's the extent of my collegiality. I hope she would do the same.

Another aspect to the day is the remarkable performances given by several of the Jami's Group of Losers members. What a bunch of jocks! And many weren't running at all 6 months ago. We have another JGL 6K in a month, and I really think I am going to get beat this time around.

The most awesome part of the day is how my boys ran. We signed them up for the 5K behind their backs, and they weren't super pleased about being forced to run it. But we shoved them to the start line and yelled, Good luck! as the starting horn went off. I was convinced that Carter was going to walk part of the course, or even not finish. Imagine my surprise to see Jalen booking down towards the finish line ahead of a large percentage of the pack. And Carter wasn't far behind! Jalen finished in just under 24 minutes, and Carter at about 26 minutes, smoking the pants off of their competition. Wow! There were tears in my eyes! This is why we become parents! All of the hours of drudgery and frustration that is involved in raising kids was redeemed by this one moment of glory. Definitely worth it.

So I've been in a good mood all day. I've been carb-loading all day (mainly by eating brownies). Tomorrow is the marathon. Holy crap, TOMORROW IS THE MARATHON!! I hope that the good vibes continue at least for the next 20 hours. I will be taking  Xanax tonight so that I can sleep. I will be careful with my morning breakast so as not to upset my GI tract. I will try to remain calm and focused. I will do my part and let the chips fall where they may.

Tune in tomorrow...

What am I going to wear??

The marathon is 5 short days away, and I'm starting to freak out a little. I'm not losing sleep over it (yet), but I get a pit in my stomach whenever it crosses my mind. It will only get worse as the week progresses, I'm sure.

Because the training part is over and the details of the day are worked out, I have nothing left to stress over, right? Wrong. There's one small thing that can consume my mind for the next few days. THE OUTFIT. That's right, I have become obsessed about what I am going to wear when I run this Sunday. You see, there are all sorts of details that need to go into this decision. Will it look good? And not make my butt look fat? Will it wick the sweat away from my body in an efficient fashion? Will it keep me warm early on, but not cause me to overheat as the day progresses? And most importantly, does it match one of the half dozen or so Nike baseball caps that I own?

During my training, I have mainly run in long men's Columbia shorts that have about 10 pockets. They are comfortable and functional. I can carry chapstick, gel packets, even my phone. They don't chaffe my inner thighs like running shorts do. But I was shopping at Kohl's last week and I saw a super-cute Nike outfit that consisted of black and blue running capri tights and a matching long-sleeved shirt. Perfect colors, and I have a black cap to go with it. However, the weather forcast for Sunday is out now and it looks to be a little warmer than I had planned. Well, that's easy. Surely there exists a short-sleeved version of the perfect top.

So Margaret and I headed to the stores last night. We hit 4 in all. I ended up buying a couple of shirts and another pair of tights, but none of them seemed right. None was the two-toned short sleeve shirt I was looking for. And when I tried on all of the outfits at home, I got even more discouraged. Just not right. So, over lunch today I went to a fifth store and ended up buying a bunch of additional tights, shorts, and shirts. Too much! Can't make a decision!

I will probably try a few more stores this week. Because that's who I am - obsessive. Plus, it's a great way to displace my anxiety over the race. Margaret, on the other hand, is happy with the first outfit she tried on, even if it doesn't match her cap. She will probably sleep like a baby Saturday night, too. Damn her.

Anyway, I am willing to bet that after all of that I show up at the marathon wearing my khaki men's shorts with the pockets for my gel packs and chapstick. It's tried and true, even if I don't look like a runner. I think that actually running the marathon (no matter what I'm wearing) will make me look like a runner, right?

Damn Kids (I say with love)

My kids disappoint me constantly. Don't confuse that statement with my kids being a disappointment, because there is a difference. I love my kids and I am very proud of who they are and what they've accomplished. But still, they disappoint. In what way? you may be asking. In the way that they don't follow through with my requests, er, demands. Just today, I was disappointed with 3 out of 4 kids' piano-practicing, 2 messy rooms, several food items left on the counter, just waiting to be snatched by a dog (or the kitten), one undrunk glass of milk, many fights that I had to referee, one outfit left on the bathroom floor, one large puddle of water after a bath, the way two of them balled up their piece of cake in their hands in order to eat it, misbehavior the store (wait, make that 2 stores), misbehavior at church, talking back, lying about homework being done... God, I could go on and on and ON...

If any of my employees did one half of what one of my kids did in a day, that employee would be gone. No accountability, no follow-through, lots of inter personnel conflict. Wow, my kids would be terrible to have on staff!

This is one of the ways parenting can wear a person down. The sheer volume of work to make sure that the kids get done what they need to get done (rather than me just doing it myself, because what would that teach them?) And the constant correcting and disciplining. Even though my kids are well beyond the terrible twos, I still hear myself saying the word NO (or DON'T or STOP) all the time.

I know, in a few short years, they'll be able to drive, and date, and we'll hardly ever see them, and I'll miss these days. Because they can really piss me off in one moment, but then come running for a hug and make me love them again in the next. Damn them. I can't even stay mad and hold a grudge (because I'm sure that works as a parenting technique). Which leads me to the biggest lesson of all. While I am on this earth to teach my kids a bunch of stuff in order to make them productive members of society, there is one very important thing they are teaching me.

Patience.

Jack of all trades, master of none

After a morning of anal sac rechecks, puppy visits, ear infections (and the sad case of my neighbor's cat dying of heart failure) - typical general practitioner stuff, I had a walk in (what's with these walk-ins?) at about 12:30 today. A 5 year old Yorkie in labor for a couple of hours, and not one but two amniotic sacs coming out (but no puppies).

Here's the deal. I am not an OB-GYN. I see maybe one dystocia (trouble giving birth) case a year. The problem is, there really aren't many (if any) veterinary obstetricians around. It's not a sanctioned specialty. So what do we do? Yes, we wing it!

I did a vaginal exam and could feel the puppy's head right at the entrance of the birth canal. It wasn't stuck or anything, it just wasn't feeling like coming out quite yet. But with those sacs hanging out, I didn't want to wait too long. The textbooks (yes, I often consult textbooks) say that before giving oxytocin (trade name Pitocin) to stimulate contractions, you should take an x-ray to make sure that the puppy is positioned right and that the head doesn't look too big for the birth canal. I've seen puppies get stuck in the birth canal because they've come out breach or they're too big and it's not a good thing.

Anyway, these owners had barely enough money for the exam, let alone an x-ray, let alone a C-section if needed. Again, what's with the clients who walk in instead of calling ahead, and also don't have any money? Great, I thought. If the dog needs a C-section, then their problem becomes MY problem. Because it's not like it can wait for them to come up with the money. I would have to decide if a) I can take the chance that they would pay off the bill eventually (about 50% never do)  b) I can get the owner to sign the animal over to me, do the surgery for free, and adopt out the mom and puppies (which is a lot of work, as you can imagine, and not a good way for a business to survive) or c) I could stand the guilt of sending an otherwise healthy dog home to possibly die, along with the puppies. What a mess!

The owners decided to take their chance with an oxytocin injection without an x-ray. I gave the injection and pushed a whole bunch of K-Y jelly up her vagina, and set them up in a room to see if things came out naturally. THANKFULLY, the owners came out 15 minutes later and told us she delivered! Yay! Crisis averted. She then had one more pup and I sent her home to have the rest, as I could feel at least one other puppy in her abdomen. I also sent them home with an estimate for a spay (this was her fourth litter and I think the owners were finally done). I suspect that the first two puppies' amniotic sacs and umbilical cords got sort of twisted up, because she passed the two puppies, then the two placentas, and they were all wrapped up around each other. But, as I've said before, I'm no expert.

Sometime winging it works. But I don't recommend it as a first choice.

Your kitten has a broken leg

Tuesday was a pretty calm day at work. I had an urgent care scheduled for about 5 pm, but they ended up going to the wrong clinic. Oh well, I thought. At least I can get out of work a little early and run some errands before I need to help out at my sons' soccer practice.

As I was getting ready to leave, one of my techs came into my office. There's a walk-in injured kitten. Can you see it? Of course, I said, calculating how long it would take vs. when I needed to be at practice. There should still be time.

The poor 4 month old kitten had been found trapped under the owner's tool box for almost 24 hours. The owner heard a crash the night before, but didn't get out of bed to investigate. Then he went to work the next morning without thinking about the kitten, and didn't realize something was amiss until he came home from work and Kitten didn't greet him at the door.

Kitten (not his real name. Plus, I like calling all kittens "Kitten") had a broken leg. Worse, it was his femur (the long bone that comes out of the hip socket). The bone was literally folded into a 90 degree angle. This type of fracture really requires surgery. I gave the owner an estimate of $2500-3000 to have an orthopdedic surgeon repair the leg. That was completely out of the question. Well, I've repaired a few broken bones in my career, plus the jaw repair I did last week got me all revved up, so I told the owner I could do the surgery myself (albeit, I am certainly no expert) for about $1600-1700. Still out of the question. You see, Doc, I'm in construction and the economy's been real bad, as you know. Plus, I pay too much for child support. I'm living in an apartment with my uncle here, who's been coming to your vet clinic for years. Can you work out a payment plan or something?

That's where I get into trouble. Always a sucker for a sob story. But not too much of a sucker. Yes, I replied, but I need 50% down before I do the surgery, then you can pay off the rest. I can also look into finding some charity funds, but that would only amount to a few hundred dollars.

He got on the phone with a few people, including his kids. They all decided that they really couldn't afford any surgery. Crap. Now what? Well, it is not recommended, but he is a young cat, and he may heal with just a splint. Not ideal, but it's better than nothing. Go for it, the owner said.

As I reduced the fracture and rigged some kind of traction-producing spint, I could hear the owner in the waiting room on the phone with his kids again. It sounded like they wanted to put Kitten to sleep. Well, there's no way I would allow that. He's such a young cat! With a possibly fixable problem! My mind started to race, thinking through all of my options, the main one being having the owner surrender the cat, me fixing the leg for free, and our clinic adopting him out. I've done it before, I'll likely do it again many times in my career.

In the end, the owner elected to keep the kitten. I was pretty impressed with how my splint turned out, and I hope he does come back for his weekly rechecks. And I doubly hope that Kitten's leg heals at least a little straight.

The owner also only paid about $100 of his $300 bill for the visit (he wrote a promisorry note for the rest).

I was also a half hour late for soccer practice.

Making my kids ride 36 miles in the rain

Yes, I'm a mean mom. I signed my kids up for the 36 mile Minneapolis Bike Tour again this year. I begged, bribed, and threatened to get them to do what ended up being only a handful of training rides, the longest being 15 miles (we turned back early because I couldn't take the whining any more). All along I'm thinking, What a gift I'm giving to my children! I'm giving them the fresh outdoor air, physical fitness, a sense of accomplishment, and hours of my time (albeit it time spent yelling and cajoling them to hurry up and stop crying when it feels too hard).

The Tour was this past Sunday. It was cold and wet. Awesome. Thankfully, I had also managed to convince a few others to join us, which was a godsend since Lisa had to work and I didn't know how I was going to manage the 4 kids on my own. The morning got off to a fabulous start when my friend Phil called to say that he and his two kids were already there and my family hadn't even left our house! We finally got the bikes loaded up and the raingear packed, and we made it almost on time. What I didn't realize was that "almost on time" was right at the end of the official start time. Our group was among the last to cross the starting line, and, of course, one of the slowest. That meant that we arrived at each of the break stations almost as they were closing them down. After the second station, at 17 miles, Carter wiped out due to the wet street and hurt his knee. I didn't see it; in fact I had to ride my bike back about 1/2 mile to find him, limping back to the station with the help of one of the course attendants. He was sore and crying, but I talked him into getting back on the bike. It really wasn't a very bad injury. But now we were at least a couple of miles behind the rest of our group and to make it even better, it started to pour rain. So here I am, riding with a wet crying child with a sore knee, knowing that we weren't even halfway through but had no choice but to finish. It was a lonely and depressing time. I tried to be a cheerleader, but it's really not my style. My style was one of, Well, there's no way out of this, so we might as well finish, and it's raining and we need to pick up the pace so let's go already!

We made it to the third stop just as Jalen and one of Phil's kids were leaving. Thankfully, my friends Karin and Dan took off after them so that the boys weren't without any adult supervision on the ride. Also thankfully, the rain stopped temporarily and Carter's attitude improved a bit. Now it was Claire's turn to melt down, and again I dealt with that by yelling at her to just hurry up so we could get out of the rain! We finished the ride about 4 hours after starting, much to the surprise of (the few) volunteers at the end. Yep, our 7 year old girls rode 36 miles. So there.

Am I glad we did it? Yes. Are the kids glad? I'm not so sure. They don't seem impressed with the distance they traveled, even after I've told them countless times how proud I am. The problem is, I like to push myself and I consider adversity a challenge that can (and should) be overcome, but my kids don't have the same mindset. Maybe it's their age, or maybe they just aren't cut out of the same cloth as I am. If I really think about it, I don't know what kind of person I was at age 7, or even at age 10. Would I have persevered for 36 miles on my own like I would now? Or is determination a trait I developed as I matured?

One lesson learned is that my kids will be who they are, in spite of my efforts.

Another lesson I learned is that my kids did come through in the end, and that is just awesome.

Appointments 15 and 16

Can you believe it's been 6 months since my first mammogram? That means it is time for my 6 month follow up. So this morning I made the trip through Minneapolis rush hour traffic to the Piper Breast Center for my 6th! mammogram since February 28. But it's been so long I almost forgot what it was like. OK, not really. I'm a seasoned veteran down at Piper, so I knew the routine pretty well. State your name at check-in, pay the co-pay, hold your arm out for the wrist band, bring your check-in sheets to the volunteer. I only had to wait a couple of minutes before I was led to the changing room. This time I got a robe! Yay! No hospital gown for me! I think I've figured it out. If you're wearing a robe, you're just in for a mammogram. If you're wearing a gown, you're having a procedure done. If you're wearing a gown AND they don't offer you a beverage, you're having surgery. Now I know how to tell what the other patients are there for. Ha!

The mammogram technician called me in and asked to confirm my history. So you had cancer? Um, not really. But it says here that you had DCIS on the stereotactic biopsy. Yeah, but they changed it to ADH after the surgery. But the core biopsy said cancer. Yeah, I know, but they're treating me like ADH, not DCIS. Well, the biopsy said cancer, so that's what I'll put down, she said. Hmmm, we don't get a diagnosis change like that very often, so it's a little confusing. YOU THINK? I thought to myself.

Anyway, she asked to see the scar and made a little slash line on the computer illustration of my right breast. That doesn't look like my scar, I said (always the comedian, I am). Well, I'm sort of limited with this program, she replied. I know, I was just joking. Then it was time for the big squeeze. You know, no matter how experienced the tech is, there is no way to perform a mammogram and NOT have it be the most awkward experience of your life.

I only had to wait about 15 minutes and the report was done. I was handed a nice letter that stated, Dear Ms. Stromberg: Your mammogram was read out and we are happy to inform you that it is NORMAL (no cancer). Wow, I haven't had one of those letters before. So that's what it feels like to have a normal mammogram. I took my letter and proceded to keep myself busy (mainly by rollerblading around the Mpls lakes and taking myself out to Panera for lunch) until my 1 o'clock oncology appoinment. Back to the oncology buliding across the street from Piper. I feel guilty going there because I don't have cancer and I assume everyone else there does.

The oncologist came in, all effusive and happy. He shook my hand like 3 times. He had just come back from the Monday noon lunch meeting, which is about breast cancer. Funny, he said. We were talking about people just like you. People with ADH or noninvasive cancer who choose NOT to take tamoxifen. Your surgeon was there and she (being a surgeon, wants to FIX everything) can't believe that anyone wouldn't take the drug. But I see the shades of gray, and I know it's not for everyone. And with the side effects you had (which, by the way, was not only hot flashes and mood swings, but also the heaviest bleeding I've ever had) it's not worth ruining your quality of life for a miniscule improvement in odds. Good. So we were in agreement on that. He did a pretty full exam and deemed me too healthy for oncology. So you're kicking me out? I asked. Well, I'm always here if you need me. He wants to send me to the High Risk Breast Clinic back at Piper for my follow ups.

So that's it. A clean bill of health. My next appointment will be an MRI in 6 months. I'm not sure if I'll stick with my surgeon (whom I like, even if she tried to talk me into a mastectomy and doesn't have a very good bedside manner) or if I'll try the the surgeon and internist who work at the high risk clinic. I have a few months to make that decision.

I'd like to say that all is well and I'm happy, but there's a part of me that can't figure out what this means for my life. Like I want to take this experience and become a better person for it, but I don't know how, or if I even need to. Is it a life changer? In some ways, yes. But here I am 6 months later and what really has changed? Is it possible to change at the age of 41? Do I even need to change my life or my personality? Or could I accidentally change it for the worse? What is the meaning of life anyway? More mental processing needs to go on to figure those questions out, that's for sure. Until I figure it out, or figure out that I don't need to figure it out, I'll continue to schlep my way through the days and hope that the world is a better place for it.

Bad week/good week

I have had a bunch of weird frustrating cases at work lately. One that really stands out in my mind is an 18 month old golden retriever who had all sorts of weird problems, resulting in me doing a huge work up over a 2 week period of time (including x-rays, a ton of bloodwork, skin biopsies, and an ultrasound). The owners are a young couple with limited finances and I felt bad spending so much of their money, but his case really did baffle me (and a bunch of other people as well.)  The end result - he probably has cancer and I put him to sleep yesterday. The owners did approve an autopsy (which I offered to pay for because I really want to know what caused his weird signs). Very sad. I don't cry often at euthanasias but I teared up with this one.

The same day (yesterday), I referred a profoundly anemic 4 year old dog to a specialist for a bone marrow biopsy and blood transfusions. This dog also has a good chance of having cancer. Also yesterday I saw a patient of mine who is less than a year old but has had weird GI issues for many months. This time was different, however. For one thing, he had a high fever. For another, he had an abdominal mass. After a long discussion with the owner about the many possibilities (and need for surgery ASAP), she ended up deciding to euthanize him. That was a tough one and I teared up AGAIN. Twice in one day!

Notice how all of these dogs are young? Hate that.

So today I walk into work and have on the schedule a tooth extraction on a 7 month old dog. She broke her tooth fighting with another dog (yes, she's a pitbull). However, after sedating this pup and taking dental x-rays, I found that she also had a fractured jaw! Great! A full morning of appointments, an animal under anesthesia, and I don't know how to fix a jaw fracture! I called a surgeon for advice (the owner declined referral, which is what I really wanted to do) and removed the rest of the broken tooth and wired the jaw together. I don't do orthopedic surgeries, so all of the orthopedic supplies had to brought up from the clinic basement.

But it was fun to do somehting different and to (hopefully) fix this dog. Fixing youg dogs' problems are not something I've been able to do much of lately.

So I'm ending the week on a good note. Let's hope that continues (the day is only half over). I also posted a pic of my fracture repair. The fracture is actually behind the big tooth and you can't see the back end of my figure 8 wire job, which goes through the bone. Feel free to critique...

My massage

It's not like I've never had a massage before, but I've never had a massage that I've enjoyed. My previous experiences were a) a Swedish massage that hurt like hell but I was too shy to say anything and b) deep tissue work done by my sports chiropractor, who dons her Latex Gloves of Pain and literally makes me cry.

But I have heard so many good things about massage, how relaxing and rejeuvinating it is, how it can prevent muscle injury, and how even people with financial hardship will try to find a way to pay for at least one massage a month. So after my long run yesterday (when my calves were slowly starting to tighten into knots), I called Massage Envy. Why Massage Envy? Because it's cheap. Only $39 for your first time! Can't go wrong with that. Plus, they had open appointments the very same day.

I arrived at 8:45 pm. Yes, it's late, but they also have convenient evening hours! The consultant took a history and recommended the Sports Muscle Package (or some such thing), for an additional $12. Sure, what the heck. I met the massage therapist, a woman who appeared in her 20's (I don't imagine this career can span decades - don't they get hand arthritis after awhile?). She was very quiet and professional. I was taken to a private room, which was warm and had relaxing yoga-type music playing. I disrobed to my comfort, which was to bra and underwear. That's when I remembered that I had on an old worn bra, not a nice stylish one. Shoot! Since my other option was to take it off, I went with the worn-out look.

The massage itself lasted about 50 minutes, with the last 15 being the application of some product that smelled like Ben-Gay. I have to admit the whole experience was wonderful. Initially, I had wondered how a person could ever want a 2 hours massage and now I know! All she did was my lower back, feet, and legs in the time she had. I totally could have stayed for more. And I did feel relaxed and refreshed.

When checking out, I was so relaxed and, well, dazed, that I somehow got myself signed up for a membership. For $49 a month, I get one massage and discounts off of more. I really don't know the details, but it sure seemed like a good idea at the time!

I can see myself getting a massage a month. It was nice to take a step back and be pampered for an hour. And I hardly thought about anything important during that time. Actually, what I thought about the most is how much I wanted to ask her questions. Like, Do your hands get tired? Do you ever have to massage icky smelly people? Do you talk about your clients to the other massage therapists? But I don't know the protocol (this isn't a beauty salon after all), so I kept my mouth shut. Some people get pedicures, and we know how that went for me. I think a massage is more my thing. I encourage you to at least give it a try. Oh, and if you do, I have some referral discounts available!

Long run attempt #2

I'm tired of running. OK, I'm tired of training for the marathon, which is decreasing my desire to run. I can't just go out for fun any more. Every run has to have a purpose and must be planned in advance. I'm tired of the time commitment - an entire summer and early fall of running, running, running. I have to block off a big chunk of time every week for a long run, and try to strategically schedule some other runs in as well. I'm tired of the physical pain during and after each long run. I'm also tired of the emotional rollercoaster that accompanies said physical pain.

Having said all of that, I did another long run today. I know, I know. I said I wasn't going to do any more until the marathon, but I just couldn't let last week's run be my last big run before the race. I just didn't feel good about it. So against the advice of many of my running friends, I went out again this morning.

Oh, and it's exhausting just getting ready  for a long run! There's the pre-hydration, pre-run Advil, light snack that will provide energy but not upset my GI tract, shot of caffeine, taping my knee, putting moleskin on my foot to prevent more blisters, starting my GPS, getting my iPod working... man, it took 1/2 an hour just to get out the door this morning! So much for running being quick and easy!

I started out at 6:30, alone (except for my dog Marley). I didn't know how far or how fast I would be able to go and I didn't want to encumber anyone if it didn't go well. It was warmer and more humid than it's been in awhile. I wore my Merrell shoes with very minimal soles - the ones that wrecked my calves a few weeks ago. However, these shoes save my knees and I'd rather have sore calves than sore knees at this point.

I did three loops of 5.6 miles, and added an out-and-back of 1.2 miles at the end, for a total of 18 miles. I felt great throughout the run, save the foot and calf pain. I never felt tired, in spite of the heat amd humidity, and was able to maintain a running pace of about 9:30 min/miles for the entire 18 miles. I didn't even slow down at the end! My knees held up, and the only damage was a recurrence of the foot blister (which, probably because of the moleskin, never bothered me during the run). The best part about it is that I stopped because I hit my goal, not because I had to due to injury.

The totals of this run are:
100 calorie pudding snack before run
3 Shot Blocks after 60 minutes
1 Powerade energy and electrolyte bar after the second 60 minutes
32 ounces of water
2 hours and 52 minutes (plus breaks - I cheated and stopped my watch for those)

I know this is a little TMI, but I talked about my boobs for 2 months, so what the heck. When I urinated an hour after the run, it was the darkest gold/brown I've ever seen! I am not sure if I was really that dehydrated, or if maybe there was a little myoglobin (a product of muscle breakdown) in there. The weird thing is I felt, and continue to feel, fine! It's not like my body told me to quit or anything. Anyway, weird.

So, I'm glad I did it. I feel good now about the marathon in 3 weeks. Now I start my taper, which, according to the experts, will result in weight gain, insomnia, restlessness, anxiety, and depression. Wow, I can't wait! Maybe the training part wasn't so bad after all...

Oh, and today I'm going to do something I've never done before. I'm going to pay for a massage.

Sometimes you just have a bad run

It's pretty amazing how sometimes you can do everything wrong and things work out, and do everything right and they don't. This is true in running as well as in life. I remember my long run 2 weeks ago - my calves were sore before we even started, we got up at the God-awful time of 4 am, and my bedtime snack the night before was a big ice cream cone. But I made it 15 miles with, in retrospect, relatively few problems.

Today I had plans for an 18 miler, my longest to date, and my last long run before the marathon. In preparation for this run I'd been taking it easy (no long run for 2 weeks and no footwear changes). My legs felt great and I was ready to go at 5:20 this morning. The weather was also in my favor - a cool 50 degrees - perfect runing weather.

I met Margaret at the one mile point and we headed for an 8 mile loop in the park reserve. Those first 8-9 miles went great, but things started to fall apart at mile 10. My legs were sore/tired/sluggish, and my feet hurt as well. I'm sure Margaret was a little frustrated (although she didn't show it) because I kept making us stop to stretch. I stopped at my house at mile 13.5 to change shoes and take some Advil. Even that didn't help and by mile 15 I called it quits. My IT band started to hurt petty badly that last mile and I know from experience not to push that one.

I walked a mile and a half home, so **technically** I did 16.5 miles, but I really only ran 15. The competitor in me wants to go out later today and run that last 3 miles, but intuitively I know that may not be the best thing for my legs. They just don't want to run today!

Running with a partner is good in many ways. The miles fly by when you're distracted by talking, and a partner will push you to go farther and faster than you would on your own. But having a running partner also means letting down someone other than yourself if you're not running well. And you can't hide your failures if you're not alone (although I guess that by blogging this, I'm not doing much hiding anyway).

As much as I'm disappointed, I am not defined by my training runs. OK, I may not even be defined by my marathon performance. People will still like me even if I don't meet my running goals. Right?


The Twin Cities Marathon is on October 2, in 25 days. I'm not going to do any more long runs, as I am starting my "taper" before the big race. I hope that I can at least gut it out for 26.2 miles, even if my body feels otherwise. Or better yet, maybe October 2 will be the day my legs decide to show up and put on the performance of their life. All I know is that I cannot predict how a run, any run, will go. We'll just have to see what happens.

How important is a clean room, anyway?

Well, the kids went back to school today. THANK FREAKING GOD!!!! I swear I was one day from disowning them all. I think that being together 24/7 did not strengthen their sibling bonds, to say the least. We will need to come up with a different childcare arrangement (maybe separate summer-long camps for each of them?) next summer for sure.

Parenting continues to be the biggest challenge in my life. I am not wired to handle the irrationality that comes with every kid. I need order, predictability, or at least the ability to reason with one another. For instance, yesterday we gave the girls the simple task of picking up their room. They can destroy their room in a matter of minutes. They don't even close their drawers, for crying out loud. Who taught them that?? Anyway, I could have had the job done in about 10 minutes. They were in their room for THREE HOURS!!! We tried bribing, threats of punishment, reasoning with them, screaming at them... Nothing worked. It boggles my mind! I have a doctorate degree! Why can't I figure this out???

Eventually the room was pretty well cleaned. But I know that when they get home from school today, within a short period of time it will look exactly like it did yesterday. Why bother, really? Maybe I'm going at this all wrong. How important, really, is a clean room? Why not just keep the door closed and let them mess it up however they want? Maybe I just need to let the clean room thing go and be happy that they don't smoke or steal and get good grades. Is this just a phase? Will they eventually come around and realize that a clean room is a good thing? Or is it even a good thing after all?

Well, the roommate I had my freshman year in the college dorm was the sloppiest person I had (until Morgan and Claire came along, anyway) ever met. And it really bothered me! She was also lazy and unfocused and really just there to party. I think she failed out of college after a couple of years. Maybe my memories of her are what's making me so anal about the room. Maybe I think my daughters will grow up to be just like her. 

Or not. I was sort of sloppy when younger and not only did I complete college, but I actually try to keep a neat house. So there is hope, right?

Ugh, like I said, this parenting thing has really tthrown me for a big old loop. Will my decision to make them clean their room or not alter the course of their lives and possibly determine whether they graduate from college?? Are they, as I suspect, genetically wired to do their own thing despite what we as parents may want from them?

Maybe I'll have the answers someday. Or maybe some of you seasoned parents can give me the answers now.

Sometimes I'm an idiot

So, remember my post about no longer being cheap? True to my word, I bought a new Bontrager bike bag last month. This is the kind of bag that goes on a rack behind your bike seat. This particular pack has a latch system for easy installation and removal from the rack, as well as side pockets that turn into panniers when you need exra storage. I paid a lot for this little bag (maybe $90), but I bought it at the local bike store, so I figured I was also doing my part to help the local economy and all.

Anyway, I have been very pleased with my new little bike rack pack.

Fast forward to last weekend. Camping. Since the billboards from the DNR practically make me pledge not to move firewood around the state (due mainly to the emerald ash borer), I am a good little citizen and I buy my firewood at the state park. $5 for a dozen little pieces that burn up in about 90 minutes. On Sunday, most of the campground cleared out, but we still had another night. I got the brilliant idea to go around the campground and take any firewood that was left behind. What a coup! I even got the kids involved.

Since some of the campsites were a ways away, I had my second brilliant idea of the day. Let's ride our bikes around! The only challenge was hauling the wood back on our bikes, but my new bike bag (with the panniers unfolded) came in handy for the hauling of the wood. My best find was a rather large, half burned log. This piece obviously wasn't sold by the state park; this was a REAL piece of firewood. It would probably burn for another 3 hours! So what if it still was a little warm. I could pick it up with my bare hands. Which I did. And placed it on top of my new bike pack for the 1/4 mile ride back to our campsite.

The first thing Lisa said upon my arrival was, What's up with the log? It's still burning! What?? Sure enough, part of the log still had red embers. Uh oh. I didn't see that part. You know, the flaming part.

Wouldn't you know, it burned several holes in my brand new bag. And worse, it burned completely through the zipper as well. My bag is still usable, but it is now imperfect, and I have to decide if I'm ok with that.

So yes, in my quest to save $5 on firewood, I ruined a $90 bike bag. Ms. Cheap reared her ugly head just when I thought I was safe from her. The irony in this situation is twofold. First, had I bought a cheap bike bag, I wouldn't be out so much money. And second, the next day we left behind lots of unused firewood for the next campers. Didn't need that big log after all.

15 miles, part 2

My last "long" run was on July 18th, one of the hottest, most humid days of the year. I was very proud of myself for sticking it out in that weather, but it resulted in a foot injury that caused me to take an entire month off of running. I started back up last week, and since the marathon is only 6 weeks away, I have some time to make up for!

I ran 7 miles on Monday, in my super thin, flexible Merrell running shoes. They are almost like the 5-fingered shoes, just without the 5 fingers. Running so far in my Merrells after such a long break was a big mistake on my part. At about mile 3 my calves started to tighten up, and they were on fire by the time I finished. Stupid, stupid! Why do I do this to myself??? Anyway, I have been hobbling around with very sore calves since Monday. They are improving, but even just yesterday, I had to use the guard rail to support me going down stairs.

Today was a big day. My first long run in quite some time. The weather was much better than last time, but I started out with sore legs, so it felt like I'd already been running 10 miles before I even began. Oh, and because I wanted to get the run in before work, I woke up at the ungodly hour of 4 am. 4 AM!! Luckily, Margaret agreed to run with me; if not, I am sure I would have hit the snooze bar every 9 minutes until 7 am.

Some runs are good and some runs are not so good. I would put this one in the latter catergory. Every hill - both up and down - was painful, and we run a pretty hilly course. But, it was also a good run. It was humid, but not hot, and we got to watch the sun rise over the lake. Also, because NOBODY else is crazy enough to be out on the path so early, I didn't have to have my dog on a leash.

Although it was a struggle, I finished the 15 miles in 2 hours and 29 minutes, which is just shy of 10 minute miles. My half marathon time would have been 2 hours and 10 minutes, not bad for just a casual run - we are going for distance, not time in these long runs, and in fact had to slow ourselves down early on. Not so much of a problem later, but I will say that I finished the last mile in under 10 minutes, which I think is a pretty good accomplishment.

It's good to get that over with and to know that my knee and foot could handle it. I am not going to run at all for the next week - I really need to allow my legs to recover. Maybe a 7 miler next week, then 16-17 miles the following week, them I'm done. I will consider myself fully trained for the marathon on October 2. Wow. Can it really happen?

Training for a marathon, even when training with a friend (yes, Margaret agreed to run the marathon as well!), is a very personal journey. Unlike in team sports, only I am affected by how I do. Only I know exactly how my body feels at any given moment. Only I have to figure out how to train adequately without wrecking my body. And that is not an easy task. Only I have to dig down deep to finish those last few miles or even steps.

I wouldn't say it's lonely. But it is hard.

The case of Sassy (not her real name) the dog

Let me tell you about a case I saw at the vet cinic last week. My shift ended at 6 and I was supposed to go to a kayaking class at REI at 6:30. At 4:30, my receptionist asked me if I could see a dog with bloody diarrhea. Since most of these cases are pretty quick appointments, I said sure. So we added Sassy to our already full schedule.

Sassy and her family arrived at 4:45, just like they said they would. I had seen her once before, although we aren't their regular clinic. The tech called me right into the room because Sassy did not look good. She was so weak she couldn't stand, her gums were pale, and her hear rate was elevated. This dog needed hospitalization and a relatively extensive work up. We rushed her back and started an IV right away. I then presented an estimate for about $600-700 for initial diagnostics and stabilization at our clinic, but I made it clear that she would then need to be transferred to a 24 hours facility for further care, at an additional expense. The owner ok'd the estimate and we got to work. This dog had multiple problems, including elevated liver and pancreas values, messed up electrolytes, and an extremely high white blood cell count. She was breathig rapidly and had a very painful abdomen.

After going through all of this with the owner, we decided to transfer her to the U of MN. However, after I called in the referral, the owner wanted to talk again. Turns out she was having second thoughts about going to the U. The dog was old(er) and they didn't have a lot of money. I managed to talk them in to at least going there for overnight hospitalization, as I really did not want to send this dog home. On occasion, I have eed known to bring sick patients home on IV's and house them in our bathtub, but this pet was too sick even for that.

During all of this, I had to see my routinely scheduled appointments as well. And wouldn't you know, I didn't get out of there until almost 7, too late to make my kayaking class.

A few hours later, the doc at the U of MN called me with an update. After spending several hours going back and forth, the owners decided to take the dog home against medical advice. They were really nice about it, but they told her they didn't have enough money for even the basic care. Shoot, if they'd been up front with me in the first place, I maybe wiould have taken the dog home after all. A night in the bathtub on IV fluids is better than a night at home with no fluids.

So of course I lost a little sleep over that one. Sassy was due to come in at 8 am the next morning for a recheck. What woould I walk into when I got to work? Would she make it through the night? Would she be in worse shape than before?

Pleasant surprise - Sassy was doing better! Not 100%, mind you, but maybe 50% better. I gave the owners yet another estimate. Actually, two estimates. One for another day in the hospital, and the second for outpatient treatment, which would be cheaper. Guess which one the owners chose? Yes, the first plan!

So she stayed in the hospital on IV fluids, pain meds, and antibiotics. I discharged her Friday night and saw her again for a recheck Saturday morning - she was almost back to her old self. She's having repeat blood work tomorrow. I would guess that the owners spent $1300 at my clinic, plus whatever her trip to the U cost.

I don't know why they declined treatment at the U, but let me do whatever the next day. Maybe it's because the dog was getting better and they were more willing to spend more money with a better prognosis. Maybe they just had a change of heart. All I know is that I wish they had been more honest with their limitations (although in the end there didn't seem to be that many) at the beginning of treatment. The U of MN vet felt really bad that she had to send her home that first night. If I had known the owners wouldn't have admitted her, I would have offered up my bathtub. I already missed my class, so I had the evening free after all.

At least the story has a happy ending. The dog is better, the owners are happy, and I got paid (which doesn't always happen in this business either - but that's for another post). I feel pretty good about all that.

I'm a runner again!

It has been over 3 weeks since I last ran, which is counterproductive to training for a marathon. On my last long run I developed what I will call a sprain in my left foot/ankle. until now, I couldn't run more than a few steps without excruciating pain. So I have put many miles on my bike and rollerblades lately, passing with jealousy the runners on the trail. Especially my running buddy Margaret, who was out there every damned day, and who also started to break my personal records in a couple of 5Ks while I was injured. I suspect she had something to do with my foot. Right, Margaret?

So today I felt like it was time to try again. And guess what? I ran a mile!! OK, it's a far cry from the 18 miles that I should be doing right now, but it's infinitely more than I've been able to run. Tomorrow I may shoot for 2 miles.

Of course, when I ran my mile today, I had to walk the mile back home (I know, poor planning on my part). And of course I passed a couple of runners twice - once while running and once while walking. I feel like I am being judged. Like I am too out of shape to run the whole way. I am sure that's NOT what they're thinking, but I still feel like I should say something to let them know that I'm INJURED.

Speaking of injuries, one of my greatest fears (and, according to Runner's World magazine, the greatest fear of most runners) is the fear of injury. An unexpected injury can derail your whole season. And now I don't just have my IT band to worry about; now I have to think about my foot as well. Grrr!

The good news is I haven't allowed this latest setback to depress me too much. Maybe it's because I still have 8 weeks until the marathon. Maybe it's because I have finally figured out that when it comes to running injuries, it truly "is what it is". Ain't nothin' I can do about it, except rest, cross-train, and practice the art of patience. I am hoping that this time that will be enough.

Tamoxifen FAIL

Aaaaaahhh.... estrogen. Who knew this little hormone would be so important to my well-being? It has been about 4 days since I took my last dose of tamoxifen and it's like cloud has been lifted. I didn't realize how much this vile drug had been affecting me until I put my foot down and just stopped. Actually, Lisa is the one who tipped the scale towards not taking it anymore. When I asked her if I should continue taking it, her only response was, "I hate that drug." She has always wanted me to be as aggressive as possible, and has the most to lose if I die from breast cancer (being that she would have to raise 4 kids on her own and all), so when SHE told me to stop, that meant something! I am not completely back to normal, but my mood has definitely improved, as have the hot/nausea flashes. This experience has made me a little afraid for what's going to happen to me when I actually hit menopause, but I am hoping that it will be different, being that it will be a gradual, natural process, not a suddenly, chemically-induced event.

I feel pretty good about my decision. I mean, it did give it a try. But this disease has hijacked my mental and emotional health for the spring and the greater part of the summer, and it's time for me to take my life back. Plus, it's not like I am going against medical advice or anything. In fact, my oncologist had told me that about 1/2 of the women in my situation elect to not even start the drug at all! And if I actually got breast cancer, I would probably take it again. Or not. I would actually consider a mastectomy before having to go on this medication, that's how bad it was.

I will still be diligently on top of my breast health, going in every 6 months for a check. I am even doing breast self exams every week, which is way more frequently than the NEVER that I did before. I realize that some of you may think that I am crazy for not taking every possible precaution, but my risk, overall, is still pretty low. I think it is statistically 5-6% over the next 5 years. I can live with that, way better than life with tamoxifen.

I'm a hot mess. Literally.

OK, 40 days into tamoxifen and I've become a crazy person. I told Lisa that she's probably going to leave me either now or when I really hit menopause, so she may just want to get it over with. Surprisingly, she hasn't left yet. I don't exactly remember the details of being a young teenager, but I imagine I was a lot like the 13 year olds I see now. Which is, borderline schitzophrenic. Now on the other end of my reproductive life, I'm feeling 13 all over again. I can be fine one minute but then I will explode with a mini-tantrum (usually in public, of course) the next minute. What happens is that I get these waves of flashes that results not only in me being hot, but also in me feeling faint and nauseas. Or like I'm going to have a seizure. Hard to explain. They happen several times a day and last only a minute or two, but the effects can linger.

Yes, I've talked to the doctor and we've cut the dose in half and changed the time of day I take it. However, I have the feeling that my time on this drug will be a short one. I go in for my recheck in September so I would like to make it until then, but we'll see. Since I don't actually have cancer and I am only using this to prevent it, I am not willing to risk my happiness for the slight benefit it gives me. If I get cancer I don't think I would feel bad because I really did try. I've thought this through and I'm ok with that.

I know you've also been wondering about my marathon training. I have run about 1/4 mile in the past 2 weeks. The sore foot that came up during my 15 mile run has really been hindering my running. I can walk ok, but it is excruciating to run. Man, if it's not one thing it's another, right? I plan to try again in 10 days, but in the meantime I'm biking and rollerblading like mad. I even got a sweet new pair of blades (with ABEC 9 bearings and 90 mm wheels).

I still am trying to find happiness. The crazy drug isn't helping. My sore elbow isn't helping. My bad foot certainly isn't helping. But it goes deeper than that. Having seen my mortality, I have a new take on things but it's not like in the movies where one suddenly embraces life after a big event. For one thing, I think I've done a pretty good job embracing it up until now. For another, I can't seem to figure out what I want for the rest of my life. I am in the fortunate position to have many opportunities, but that may actually make it harder to commit. One opportunity I have is to cut my hours at work a little. Maybe by 5 a week. For the first time since graduating vet school, I wouldn't be working full time. I feel sort of guilty about that, especially since I own the practice, for crying out loud, but on the other hand, if I can afford it, why not? I can spend those 5 hours doing other things I love, including spending more time with the kids, going to the gym (petty, I know), starting some new projects, or even advancing my veterinary career.

I haven't made a decision on that yet. What I'm afraid of is if I work less but I'm still not happy. Then what? Ugh. Well, I think I have to try it. And I think I have to get off of this drug. And heal my foot. Then maybe things will turn around.

So far, Tamoxifen sucks

OK, I'm trying to be a trooper about this. I'm trying to have an open mind. I'm trying to stick with it. It's just hard.

I started Tamoxifen one month ago. In fact, yesterday I picked up my first refill. Of (potentially) 59 refills if I stay on the drug for the recommended 5 years. A review - tamoxifen is a drug that changes the way estrogen affects different parts of the body. For most people, it decreases estrogen's effects in the breast, making it very useful in treating breast cancer (since most breast cancers are estrogen-responsive), and in preventing breast cancer in high-risk patients. However, tamoxifen also affects other parts of your body. In most women, it increases estrogen's effects in the uterus (resulting in a thickened uterine lining and increased vaginal secretions) and in the bone, reducing osteoporosis. It also screws up the temperature regulation system in the hypothalamus, resulting in hot flashes in up to 60% of women taking the drug. Apparently, this side effect gets better with time. I am counting on that.

I had some GI upset the first few weeks on the drug. I also had some cramping and spotting, but not too bad. However, lately I've been waking up in a sweat a few times a night. I didn't figure out until today that it was hot flashes! Why today? Well, they started in force today. They come on in a flush of heat and a little nausea and last maybe a couple of minutes. I think I have had a dozen hot flashes today. Let me tell you, it kind of sucks. I'm too young to be having menopause symptoms, especially when I'll have to go through it all again in about ten years.

So why take the drug? I don't even have cancer, right? Is it worth these effects to maybe prevent me from getting cancer in the future? I really don't know. What I do know is that if the symptoms don't get better, I won't put up with it for five years. But I will try to stick it out a couple more months until my next oncology appointment. I feel like I should do something, and I also realize that these symptoms are nothing compared to what patients undergoing chemotherapy have to put up with. So maybe I'm doing it in solidarity with all of the cancer patients who are dealing with much worse.

Maybe, however, I want to feel like a cancer patient. Not that I want cancer, but I want to feel like what I've been through wasn't for nothing. That I'm doing something to treat something. That the big chunk is missing out of my right breast for a reason.

It's easy to get philosophical about things like this, especially if you're an over analyzer like me. I'll keep you posted about the physical and, I suppose, emotional side effects of this drug.

And to all my menopausal friends - I feel your pain.

Fifteen miles is good enough for me!

This is one hot and humid week in Minnesota. Seriously, it was more hot and humid here yesterday than in the Amazon. So I was sort of dreading my long run this morning. But I was also prepared. I woke up at 5 am, because I wanted to get started before it really got hot. I ate my typical pre-long-run breakfast of frosted mini-wheats and fruit, and also had half a shot of 5 Hour Energy, because the caffeine is a proven run-booster. I wasn't thirsty, but I drank 6 ounces of water. Gunther (my dog) and I hit the path at 5:45. At this time the temperature was 81 with a dewpoint of 71 and 69% humidity. My plan was to run around our lake 4 times this morning, stopping after each 3.7 mile lap to cool down and re-hydrate. I was also not going for speed AT ALL, just distance. The first lap went really well - it was humid, but the blazing sun hadn't come up yet. Gunther and I also came within 10 feet of a doe, 2 fawns, and a yearling. I stopped, drank, ate an energy block, and hosed myself down with a garden hose.

My friend Margaret met up with me for the second lap. It is much more fun to run with a buddy! I also switched dogs - I now had Marley. After 7.5 miles, I still felt pretty good. Stopped again at the house, drank some more Gatorade, hosed myself off again, and went out for the third lap. At this point my calves were really starting to ache, plus I had this new pain at the top of my foot. Margaret had a good idea - change shoes later in the run, so for my last lap I put on the ultra-cushy super-supportive running shoes that I last wore over a year ago. Wow! My feet felt like they were running on pillows! However, the shoes were heavy and HOT. A half mile into the last lap, I ran into another friend of mine! We'd been trying to hook up to go running together for weeks, but it never worked out. So it was awesome that we happened to meet each other just as she was starting her lap around the lake. I feel sort of bad because by this time I was running pretty slow and I probably held her back a little. She was all fresh and chipper and talkative. I could barely muster a one-word answer to her questions. Definitely a one-sided conversation. But having her there to run that last lap with me was like a gift from the running gods. I am not sure how i would have made it without her.

The last 1/2 mile went on for an eternity but I FINALLY made it home. I headed right for the garden hose (thank you, garden hose, for being there for me today) and played in the water like a little kid for quite some time. How cool and refreshing! When I finished my run at about 9 am, the sun was out in all of its glory and the temperature was 85 degrees with a dewpoint of 73 and 68% humidity.

I took my temperature after hosing myself off and it was still 2 degrees above normal. I also weighed myself before and after the run, and even though I drank 20 ounces of Gatorade and 24 ounces of water, I still lost 2 pounds.

But... my knee didn't hurt one bit!

Honestly, if I weren't about to pass out from the heat and humidity, I would have shot for 18 miles today. But I am happy with 15. Mostly because this time, my knee wasn't the limiting factor.

My Week at Work

Wow, it's only Thursday and I'm exhausted. My associate vet is out of town so I've been working more than usual. And I've seen quite a few interesting things in her absence. Let me tell you a little about them...

On Monday I diagnosed a dog with Lyme disease, another with some sort of really bad problem (likely cancer but I can't be sure given the limits of what the owner will allow me to do), and another with small cell lymphoma that I had to research a little in order to come up with a treatment plan. I also referred other two pets to the University for a work up of their problems.

On Tuesday I saw a bunch of super old cats. I swear the average age was about 18. And then I turned around and saw a litter of 6 puppies. I found bladder stones in a male standard poodle and oversaw a cardiac ultrasound on a dog whose murmur I had just diagnosed. I also saw a dog with a very high calcium level and brilliantly thought to aspirate her one oh so very slightly enlarged lymph node.

On Wednesday I saw some crabby people (What do you mean, you won't refill my dog's medication even though I've no-showed for the last 4 appointments and he's 4 months overdue for an exam? And, What do you mean I have to pay for the vaccine that was given and also for the exam that was done on a work-in basis?) and euthanized some pets (one of them being one of the old cats from before). I also saw a group of 4 farm kittens, 2 of which were Feline Leukemia positive (and sick), so I had to euthanize two kittens. Ugh. That did NOT make my day. But what did make my day was seeing, for a WELLNESS EXAM, a patient whom was diagnosed with bone cancer 8 months ago after spontaneously fracturing her leg. She has a pin in her leg and is doing GREAT! Which is not true of most bone cancer patients. I also saw a dog with a corneal ulcer and did a work up on another dog who had been vomiting all week (so far no answer on that one).

Today I found out that my high calcium dog does in fact have lymphoma so I had to make that phone call. Sad. The owner is considering chemo on his pet. I also surgically removed the eyeball in a young cat, several teeth in various animals, and some reproductive parts in a couple of other cats. The no-show owner from yesterday just no-showed again for his appointment and it was rescheduled for my last appointment of the day today. Really? So I have to stay around to see if this guy will actually come in?? Grrrrr...

I'm hoping my associate is reading this on her vacation and feeling sad that she's missing out on so much.  :)

Well, at least I can take solice in knowing that last year at this time, I was on a two week hiatus when she had to deal with the American bulldog Parvo breeder from an earlier post.

I will be very happy to get to the end of the week, especially since I have also had to work in an hour of exercise each day (part of the weight loss challenge that, yes, I made up) and I haven't been home any evening this week.

Whine, whine some more.

At least I'm not the veterinarian in Virginia who forgot her 2 year old in the car while she worked all day and didn't discover him (dead) until she got home. I actually couldn't sleep a couple of nights ago because of that. She is being charged with murder (which I think is a bit extreme given that, yes, it was wrong, but not intentional). I feel bad about the whole situation.

It's 5:38 and my 5:45 repeat no-show guy just called to reschedule his appointment to tomorrow. Anyone care to wager on whether he'll show up? Anyone?

$57 for shoes for a kid? Well, ok!

Today I took the kiddos to the Arbor Lakes Mall in Maple Grove. I was looking for a nice compost container for our kitchen at William Sonoma, plus I thought an outdoor mall would be a great way to spend a sunny summer afternoon as I bided my time until Lisa got off of work. I must say that although the kids resisted the idea (especially Carter, who really wanted to watch the Twins game on TV), the outing was actually pretty enjoyable and I think the kids had fun too. The Pop Rocks I bought them at the Good Things Store helped.

Carter just last night apparently had a growth spurt and suddenly his tennis shoes are too small. So while at the mall, we stopped by a shoe store. Upon entering, we were immediately greeted by 4 young men, employees of the store. The 16-year-old who helped us was really nice and eager, since it didn't appear there was much else going on in the store. Carter picked out a pair of sweet Reebok shoes with a bright green zig zag sole. They were pretty cool, I admit. He tried them on and ran around the store a few times, you know, to make sure they were fast shoes. So the decision was made to buy this pair and I then thought to look at the price tag. $56.99!!! Holy cow!

You know I am as cheap/frugal as they come. I know that with a coupon and some Kohl's Cash I could get this same pair for about half the amount elsewhere. But, the kid was so friendly, and we were right there...

Actually, the decision wasn't even that hard. Carter is such an inexpensive kid to have around. All he eats is peanut butter. He only needs a couple of T-shirts and he's happy. He actually wears his twin brothers old hand-me-down shoes because his feet are a size smaller. So I didn't feel bad splurging on shoes for him. And we even shelled out another $5.99 for some waterproofing spray that the 16-year-old salesman demonstrated for us.

You see, sometimes it's better to spend the extra money to make a kid happy. Both Carter and the shoe salesman. And now I don't have to drive around town later to find the same shoes at a better price. And I'm helping the local economy by spending a few extra dollars.

You kow what? I actually feel good about buying the shoes! And I'm not sure I would have felt that way a few months ago.