1/30/2010

Are we overdressed?

MargaretMargaret
Filed under: @ 12:36 pm

We were watching BBC America the other day (a quick personal note: I LOVE Direct TV. Yes, I miss getting NWCN because I tend to watch news at odd hours when the local affiliates aren’t broadcasting local news, but the fact that we are getting a HUGE range of channels, we can choose to ‘ignore’ all of the sports channels, and we get all of this without paying Comcast for second rate service and a stunted- from-birth DVR is by far enough to make up for losing Northwest news 24 X 7. ) and I ended up getting sucked in by a program called “The Truth About Online Anorexia”.

It was a fascinating and horrible look at the effect that the internet has had on anorexia. Ranging in coverage from online ideas for truly frightening “crash” diets, to the so called “Pro-Ana” (pro-anorexia) sites that encourage anorexics all over the world by posting pictures, how to tips, and a horrible, horrible list called “The Thin Commandments”.

And it got me thinking.
It’s clear that anorexia is a disease of a modern, developed society where food security is never an issue. I am somehow doubtful that, say, teen girls in Ethiopia in the mid-’80s, were at ALL prone to developing the idea that they were somehow overweight. And I can’t think that people in any country in ANY time that are personally responsible for producing their own food, those who know how hard it is to actually have food, would be prone to developing eating disorders.

But when did anorexia really become a problem in the US and worldwide? I can’t imagine in the 1950s when Marilyn Monroe and her curves were the beauty norm (and, incidentally, when pictures of Nazi concentration camp survivors were still fresh in everyone’s minds) that starving yourself to “beauty” was something that would go through anyone’s mind.

And just to clarify, I know I’m oversimplifying the problem greatly. No anorexic thinks that they are starving themselves, rather that they are “dieting” to achieve an ideal which, in their mind, is attractive and desirable. They’re not thinking about it at all, it’s the way that they’re wired. However, I don’t think that the possibility of being wired that way would be or would have been possible in the 1940s during rationing and surely not in the 1920s and 30s during the depression. When did anorexia really start?

And is anorexia not only just a disease of a modern, developed society with no question about food security, is it a disease of overdressing? If we all were prone to walking around stark naked, when everyone could see what everyone’s body looked like and that NO ONE except the terminally ill looked like walking skeletons, could the anorexic ideal image become fixed in people’s minds?
Again, a gross oversimplification. The idea of a society where everyone walks around stark naked pre supposes the concept that we had no issues with temperature control, that we were all wired to NOT think about our bodies. I guess that answers the question though. If we were all stark naked all the time, I don’t think anorexia would be possible.
Certainly willful anorexia isn’t present in the animal kingdom. As many people as I see whose pets “just WON’T eat…..” (regular pet food instead of table scraps, the diet food that I am recommending, commercial pet food instead of snooty, unbalanced “natural” raw crap, etc.) actually WILL eat what is being offered if they’re put in a situation where they have no other option. Body issues just don’t exist in critters.

Or is anorexia maybe a disease of UNDER dressing? Were everyone to dress as devout Muslim women do, covered from head to toe with only a gap for the eyes, would anyone ever be able to develop the particular pathology where they compared themselves to everyone else? That’s not quite right. Anorexics don’t necessarily compare themselves to other people, they compare themselves to the image that they have of themselves. But could that image develop if no one EVER was able to see another’s body outside the marriage bed? If you never had any idea of how the body of another person of your gender looked like, could you develop the notion that yours was wrong?

I’m not going to get into the question of rates of anorexia in devout Muslim areas versus those in areas where religious devotion is less avid because there’s no way to get any sort accurate information about it. This isn’t a discussion of religion, mind, I’m more interested in the psychology of the question.

And though recovered anorexics that I’ve known who were anorexics pre-internet managed to do just fine in starving themselves mostly to death without online help I have no doubt at all that my current medium of choice is no damn help at all. Are rates of anorexia higher now than they were in 1980?

I’m really glad I never got into human psychology. I’d spend far too much time inside my own head to be of any use to anyone.

1/24/2010

To Lighten The Mood A Bit

MargaretMargaret
Filed under: @ 5:19 pm

My last post was rather a downer and I’ve managed to restrain myself from posting syrupy cute kitten photos for a while, but I just can’t manage to do it anymore.

KITTENS!

Sunshine Pogo Ears

Flitter sleeps in driftwood

1/15/2010

Electrical Gremlins

MargaretMargaret
Filed under: @ 7:22 pm

This past week has to go down as one of (I’m not going to tempt fate by saying the worst) the worst weeks in my professional career.

I started the week with a concussion that I got feeding the kittens on Sunday. Please don’t ask how I got a concussion feeding kittens. Just take it for granted that Andrew is extremely grateful that I seem to be able to save all my maladroit tendencies for home.

So Monday morning I walked into work still rather lightheaded and ditzy. Head still sotto voce throbbing, but tolerable.
The network server crouched in the office was making a weird humming “I’ve got a drive running” sort of noise. However I’ve learned to stay the hell away from computers except to type on them, and since everything seemed to be running normally the morning receptionist and I just looked at each other, shrugged, and went about our day. When the boss lady showed up later that morning she called the IT guy who started running diagnostics and, as the computers were still running normally, we left Piet to do his thing with the server.

Tuesday would have shaped up into a pretty decent day for me. I was booked for surgery all day, didn’t have a single appointment scheduled so I would only have to interact with clients via telephone. This is a GOOD day for Margaret.
Breezed through five procedures (two neuters, two spays, and a bladder stone-ectomy) and was actually done in time that I could eat lunch and see a work in appointment. And (this is very important) I had all of my charts and all of my surgical reports written. I’d even managed to get all of the invoices done BEFORE anyone showed up to pick up their pet.
Now granted, I did have to delay the second spay because, since I have a tendency to throw away the disposable surgical gowns that we use (and re-use after sterilization) when they start to get a little funky, there was only one surgical gown in the building and it had to be re-sterilized before I could use it. I’d started the day with three, usually enough to get through five procedures, but since one was throw out-able, and the second TORE when I was changing gloves to close up the abdomen of the dog in whose bladder I’d been mucking about…. Well, that left just one and the autoclave takes about 90 minutes for a full cycle.
Oh well, I can adapt to that! We just jiggle the day’s schedule about a little bit, everyone got lunch and, as I said, I had time to see an appointment that needed to be seen that day (I only wish I remembered what the pet’s name was and what I saw her for).
Finished with my fifth surgery, getting things wrapped up for the day. One surgical report and one appointment chart to write up. A few phone calls to make, and then I can go home.

Then the server barfed.

And I do mean barfed. Piet The IT Guy had never seen anything like it. Three drives all committed suicide at the same time. It wasn’t a virus, it wasn’t malware, it wasn’t any sort of outside attack. I’m not sure what, exactly, was wrong with the cursed thing, but it barfed. Ghosts, pixies, Nunnahee, Menehune, whatever. SOMEthing got into our network server and it was dead. RIP.

We’re a paperless practice. That means all our medical records are -yup- stored in the computer. All the patient information? Computer. Client information? Computer. Prices? Prescription labels? APPOINTMENT BOOK? Computer, computer, computer.
Without the server the network doesn’t work. Without the network the practice management software doesn’t work. Without the practice management software we are DEAD IN THE WATER.

Since there wasn’t anything else I could do (can’t write charts, can’t make phone calls) at that point I was done with my day so I left, offering drinks at my place for whatever survivors there might be at the end of the day. We all figured that Piet would have the server back up the next morning.

We were WRONG!
Wednesday morning I walked in, there were sticky notes all over my desk detailing things that had happened the day before. Piet couldn’t do anything remotely so he was going to be coming down to see if he could resurrect the bloody server in person.
One of the first things I do when I get to work in the morning is to wander into radiology and turn on the computer that runs the digital capture station. I noticed that the computer that runs the diagnostic workstation, a bit of electronic wizardry that makes it possible for us to send the digital radiographs we take to the storage servers and, more importantly, to the radiologists, was making a funny noise. Not anything like the whirring, running drive sort of noise that the network server had been making, but a whiny sort of click.
One of the notes that was on my desk Wednesday morning was about some radiographs that had been taken on one of my patients the day before. Since I couldn’t do anything useful like writing charts or making phone calls I figured that reviewing those images would be a good use of my time while I was waiting for my first appointment to show up.
Except the images that had been sucked into the digital capture station the night before hadn’t made it the two feet to the diagnostic station. The diagnostic station, in fact, wouldn’t even bring up the bit of software that we use to view any of the films. It just sat there blinking at me. Desktop was normal. Shortcut to the viewing software was there, I could even click on the shortcut and get the “please enter password” window. I just couldn’t get past the password (and yes, I was using the correct one).
Oh god!
Piet The IT Guy doesn’t mess with the computers that are used to run our digital radiology system. Piet, in fact, is not qualified to mess with the radiology computers.
So we have to call the radiology computer people to come out and exorcise the diagnostic workstation.

In the mean time it’s time for appointments to start. Oh right! Appointments!
Mysterious people walking through the door with mysterious pets to see mysterious doctors for mysterious medical complaints. Without our appointment book we have no idea of who to expect when, with which pets. And unless the person walking through the door is familiar to us or happens to know which doctor their appointment was scheduled with……
Without medical records we have no idea of a patient’s previous history (What medications were given? For how long? What was the response?), and even the healthy ones coming in for vaccines were mysterious. What vaccines are you due for? Basically unless the critter had a rabies tag with a year on it, we couldn’t vaccinate anything. And if we could give a rabies vaccine we couldn’t issue a new tag or a certificate because, yup! No computer!
One of my favorite clients, G, showed up with her dog for a recheck Wednesday morning. At least I was familiar enough with G and her dog that I had some sort of idea what we were rechecking and what the dog’s medical condition had been at the previous exam three weeks ago. I’ve known G for heck, ten years? Twelve? I thought she’d be a nice, calm break in a day that was rapidly looking like it was going straight to hell.
G is in her mid-60s and I’ve known that she’s been dealing with colon cancer for at least the last few years. Last I knew though, she was stable. Still some evidence of metastasis, but radiation therapy was working and the outlook was optimistic.
Except Wednesday morning G told me that the radiation had failed and that she had three new metastases. Inoperable, nonresponsive to chemotherapy and, obviously, unfazed by radiation. She’s terminal. We had a discussion about what I can do to help her aging and somewhat forgetful husband keep their stable of aging and crotchety little dogs going for as long as is humane once she’s gone. I just hugged her, finished up with the patient in question then went back to my desk and cried. I’ve lost clients and been happy (for my own sake) about it, I’ve lost clients and been relieved (for their sake) about it, but never one who had managed to breach the divide between client and friend. I try to keep my professional and personal lives very separate, but G has managed to work her way into both of them. I will miss her a lot.

By Wednesday evening Piet managed to get our computers linked to HIS server and the last computer backup we had made (Monday night) shoved into his server so we at least had a few computer stations that would work. The stations were slow and we still couldn’t print prescription labels, but we could at least get charts written up and invoices charged out. We still had major chaos with the appointment book because appointments that had been made, moved, or changed between Monday evening and Wednesday afternoon were mysterious. We had double booked appointments, we had new clients coming in for no known reason, but we were making SOME progress. I got my Wednesday afternoon charts written, realized that I had to re-create all of Tuesday’s charts, write up all of Wednesday morning’s charts as well as deal with all of the lab call backs and phone messages that had been piling up since Tuesday afternoon and just gave up and went home.

Thursday morning I got to work and put my stuff down so I could sign on to my computer. I woke up the monitor and realized that Wednesday night had been one of the nights where the computers shut themselves down automatically to install updates. I restarted the computer like normal.
The remote connection to our practice management software on Piet’s server was gone.
I couldn’t do anything about it and it was way too early to call Piet, so I went into radiology to wake up the digital and, hopefully, finally have a look at those radiographs that had been taken on my patient on Tuesday. Except the diagnostic station was still barfed, and there was a note for the service rep who was supposed to show up later that morning.
I began to have fantasies about hitting myself in the face with an axe.
Our more tech savvy tech showed up and was actually able to re-establish my computer’s link with Piet’s server. So at least I had a (retarded, slow, and forgetful) computer to work on. The day is looking up.
The day definitely started to improve when the Piet and the tech managed to jury rig something so that we could actually print prescription labels. Could only print from one computer station, but this is progress no? Radiology is still down, but I don’t have to hand write prescription labels and we don’t have to guess at prices when we’re writing invoices. Heck, that’s almost luxurious.
I got ALL of my Thursday charts written. I got the rest of my Wednesday charts written, and I managed to re-create all of the surgical reports and records from Tuesday. By Thursday afternoon I still had an unholy pile of lab call backs and phone messages, including two from a deaf woman who wanted me to call her TTY connection to discuss why the cat that I’d only seen once had died abruptly just before his second appointment with me on Monday. Phone calls, schmone calls! I’m going HOME!
I went on a coffee and cookie run so the rest of the crew wouldn’t fade out while they were trying to get caught up and finish the rest of Thursday then turned towards home.
Except…..

Except just as I got to the turn that I take in front of the airport…..
My car started to lose power.
It was only one little cough and when I downshifted and stomped on the gas it went away so, maybe it was nothing.
Maybe.
Except you all know that it wasn’t.
Lost power again at the next turn I had to make about a mile from home. Downshifted and stomped on the gas, got her going again. Straightaway for the next 3/4 mile through the tunnel under the south runway for Sea Tac.
Cough, gag! (stomp, downshift, curse, pray, sweat! A tunnel under a runway would be an extremely sucky place for the car to die!)
I managed to sweet talk my car into continuing to run until the intersection of Normandy Road and Des Moines Memorial Drive. Where, for the record, the stoplight wasn’t working so it was flashing red in all four directions.
A quick left turn, a cough, a gag, a downshift and a stomp and….. PUTT.
Dead.
Halfway through a turn in the middle of the westbound lane, traffic trying to get past on either side and I could frickin’ WALK to the service station two blocks away, but I can’t get out of the car because it’s in the middle of the road. I could push the car to the service station, but the damn thing is headed UP HILL.
I called the state patrol. I called the AAA. I called my husband.
State patrol said they’d send someone out to manage the traffic around me, AAA said they’d send a tow, but it might be as much as an hour (although since I was blocking traffic they’d try to get out there faster). Andrew arranged to meet me at the service station two blocks away, but since I couldn’t leave the car, there wasn’t any point in him coming out.
A very nice off duty officer from Tenino (shout out to the Tenino police department, this dude did go above and beyond) parked his cruiser behind me with his lights on. I rolled down the window to let him know what was going on and we both agreed that he’d stay there until the state patrol showed up. The headlights went off, the console went dead, and the window wouldn’t roll up.
Did I mention that it was raining?

So I sat there getting soggy waiting for the AAA and the state patrol to show up.
Everyone eventually showed up and my car was decanted off at the service station. Finally at home and in my jammies I sat and stared for a LONG time.

I woke up this morning rather shell shocked.
Went to work.
The computer worked. It was still slow and retarded, but it worked. The gnomes that are certified to work on the radiology computers waved their magic wands and I could see the radiographs that I’d been waiting for for three days.
We still had a few mystery appointments, but they were managed in a (somewhat) timely fashion.
By 1 p.m. Piet had reappeared from Lynnwood with our resurrected server. All the computer stations worked, and ran at a decent speed. I could print prescription labels from whatever damn work station I pleased.
I could connect to our common documents file, I could print estimates, I had internet access and I could even connect to the printer to print client information pamphlets.
The service station called.
The good news is that the fix on my car was cheap.
The bad news is that they couldn’t find anything wrong with the electrical system.

With the way the rest of this week has gone, I’m not sure that I won’t die by lightning strike in the next few hours.
I’m wearing shoes with rubber soles and staying away from water.

1/11/2010

Why Veterinary Medicine is Uber Cool Part….oh, whatever.

MargaretMargaret
Filed under: @ 4:33 pm

I mentioned, back in July I think, (ah yes, here’s the correct post) that one of the reasons I love my profession is because of the wide and wild variety of species with which we deal.
Human medical people got NO idea whatsoever about how absolutely COOL medicine can be when it has to be applied to things that range from fins to legs (sometimes lots and lots of legs) to wings to carapaces.

And so I submit my experiences with opening up VIN and getting to the front page where, amongst other things, there are links posted to interesting veterinary journal articles and interesting conversations on the message boards.

Over the summer there was one day when there were links to two articles:
“Treatment of venous ulcers with surgical adhesives derived from snake venom”
and
“Notes on gestation periods and litter size in the arenicolous buthid scorpion, Leiurus quinquestriatus”

Who knew? A group of baby scorpions is a litter! And, for the record, the gestation period varies from 155 to 277 days and litter sizes range from 35 to 87 offspring. 😯
And let’s just talk about how cool it is that snake venom may be useful in treating venous ulcers (a classification that includes pressure sores and diabetic ulcers amongst others).

And just the other day I opened up the front page on VIN and dropped right into a conversation about seizures in an ostrich.

Real doctors treat more than one species!

1/7/2010

Random Neural Firings

MargaretMargaret
Filed under: @ 5:27 pm

Things that are irrelevant enough that I can’t develop them into posts of their own, but which require comment regardless.

Recently spotted bumper stickers:

“GOD HEARTS FAGS”
Noted on the bumper of a mid ’90s model Toyota also sporting a “Vampire Tattoo and Piercing Studio” bumper sticker, a rainbow ribbon magnet, and a license plate holder outlined in skulls. I thought it was notable as it was made to look rather a lot like the signs that those religious homophobes who follow a certain loudmouth apostate wave that read “GOD HATES FAGS”. The similarity was really quite remarkable. 😈

“HEY ACLU ‘Merry Christmas!'”
Noted on the bumper of (of course) a late model gigantor American SUV (a GMC Jimmy?). To which I respond, “oh get OVER yourself!”. Christianity isn’t the ONLY religion in the world, accept the fact that there are people in the world, even in the United States of America, who don’t worship like you do and that they might not appreciate what they consider a religious reference as a greeting. Consider how you’d feel if, everywhere you went, people said to you “Allah akhbar”. Upset yet? Yeah, I bet you are.
So shut the hell up about Christmas and wish people a happy holiday season. If they don’t like your Christmas then just leave them alone. 🙄

Recently heard inanities:

“Do you want a coupon book for the weekend after Thanksgiving?”
The receipt checker at the outside door of Costco asked me this as I was leaving with a $300 load of groceries. We routinely make one massive Costco run somewhat before Thanksgiving and then stay the hell away until the middle of January or so. When I was walking out the door with what obviously amounted to a huge amount of groceries, what on EARTH made him think I’d want (or need) to come back a week later? 😯
To say nothing of the fact that there is no amount of money on earth that would be enough to get me within 10 miles of Costco on the weekend after Thanksgiving.

“My cat’s got an abscess on his face, but I’m not going to take him to the vet. I wouldn’t go to the doctor myself for something like that so I won’t take my cat for something I can take care of at home.”
Really?
You wouldn’t go to a doctor if you had a massive infection on your face? You’d rather sit around with a pocket of pus under your skin and a huge fever? (and from experience I can say with certainty that cats with facial abscesses tend to have shocking fevers)
Why do people say things like that to veterinarians? If they’re trying to impress us with their compassion or savvy in treating animals they’re not. Pretty much universally we think that people who futz around with home remedies for something that we can fix quickly and definitively are complete jerks.

And, my descent into Andy Rooney-ville:

Since when have pajamas been acceptable outerwear? I have started noticing people wandering around in public in p.j. pants and sweat shirts. Weird, no? To say nothing of REMARKABLY drafty this time of year.

We have been hearing sponsorship ads on NPR from the Mini corporation. Y’know, those remarkably cute little cars? They advertise themselves on NPR as having “go-cart handling”. Erm… I don’t WANT my car to have go-cart handling. I prefer my car to have real live grown up car handling. Although, as Andrew put it, at least go-cart handling is better than bumper car handling.

1/1/2010

Happy 2010, Everybody

Uncle AndrewUncle Andrew
Filed under: @ 11:54 pm

As has become the custom, we welcomed in the new year with a cornucopia of friends, food and fire, here at Chez Us. We made pizzas, quaffed drinks of both the hard and soft variety, set off fireworks and made much merry. At 12:42am, naturallement,  we hid our heads in propitiation to the Spam God. Many thanks to the 20+ friends and family members who showed up and joined in the rannygazoo.

Like last year’s celebration, we capped off the overall experience with a bonfire, attempting for the second year in a row to completely use up the ginormous applewood stumps we got from Margaret’s parents’ house. For the second year in a row, we were unsuccessful in getting the damn things to completely burn away; this may become a yearly effort that spans well into the (un)foreseeable future. Unlike last year, however, we decided to hold said bonfire in an actual fire pit that we built from those sort of wedge-shaped concrete blocks you see holding up the more frufru retaining walls in your better neighborhoods. This was a tremendous improvement over last year’s plan, in which we dug a hole in the dormant backyard garden for the fire, thus forcing our brace of inebriated guests to stagger back and forth between our muddy backyard and our poor innocent carpets. The fire pit worked out so well that we’re going to keep it around for use in other occasions, including as a replacement for our aged and highly improvisational charcoal grill system, which consists of two army-issue roasting pans, filled with briquettes and standing on cinderblocks. I plan on getting a couple of big stainless wire racks to span the pit and use as a grill surface for our various barbecue parties. I’m also bound and determined to use it for a monster chili-pepper-roasting party next pepper season…..it’s been entirely too long since we’ve had us a big pepper-palooza.

Among the highlights of this year’s celebration was a fire-breathing demo by Jason, who brought his very own personal stash of tiki torch oil for just this purpose, even though by the time he started he could probably have just spit on the fire and gotten a similar effect.

We also took the occasion of the new fire pit as an opportunity to burn a sage bundle that my sister Meg had put together and sent us many years back from New Mexico. That makes us sound way more New-Age-Hippie-Airhead than we actually are; we weren’t trying to summon the good spirits or align our chakras. It just seemed like a good time to make a little offering to Whatever’s Out There for the plenty we seem to have more than our share of. Sage burns nice and stinky….an acrid, cleansing smell. Made a nice topper to the evening. Well, morning, really.

This year’s party was nowhere near the drunken bacchanal of least year. While the liquor flowed freely, most folks seemed to rein themselves in a bit this year; we dropped from four pukers down to one, a very respectable decrease. And no one had their face drawn on with indelible marker this year. True, one of our revelers got on his phone and started prank-calling after-hours emergency vet clinics (interestingly enough, the same reveler who later barfed), but to be fair he was kind of goaded into it by others who shall remain nameless. Ethanol surplus or no, everyone remained the fun, happy, easygoing folks they are when sober. Which is yet another thing I love about our friends; on the occasion that they get shnockered, they just become the same people that we love and respect in the first place, only more so. Our friend Steve proffered the opinion that the inhibition-lowering effects of alcohol give you a chance to see what kind of person someone really is—a happy drunk is probably happy in their regular life, a nasty drunk is probably a bit of an asshole, etc.—which in the case of our group is an encouraging thought indeed. The sight of one fellow, two and a quarter sheets into the wind, cleaning our kitchen floor with a paper towel because he was a bit scandalized at how much dirt folks were tracking in from outside, just made me want to give him a big ol’ hug and thank whatever forces shape our destiny that we have such fundamentally decent and good-hearted human beings to call our friends. Everyone should be so lucky.

It occurred to me as we were cleaning up after the party that, without expressly intending to do so, we have put ourselves in a position that pretty much perfectly accommodates the goals we envisioned for ourselves early in our domestic relationship. Back when we were still ensconced in the wilds of deepest darkest Pullman, we used to fantasize about what our lives would be like once we returned to civilization. We envisioned a home in/around Seattle, where friends would gather for parties or drop by on the spur of the moment, where we could all just sort of bask in each other’s company and fellowship. And while ’tis true that we don’t all gather together as often or as extemporaneously as we might otherwise like, this is more a factor of the crazy-demanding schedules by which most of us live our lives….sort of a “the spirit is willing but the day planner is weak” kinda thing. And when the opportunity arises and friends and family manage to congregate here, whether for a movie night, a game brunch or a birthday party, it’s always a good time. Through sheer serendipity and some effort, we have created a home in which folks seem to feel welcome, which is really the very best we could have hoped for.

To all of our friends and family, near or far, the very best in Ought Ten.


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