In Memory of Herman

In my 55 years, 363 days on this Earth, I have dealt with many sad events, but today I will have to euthanize my best friend - my dog, Herman. This will rank high on the list of sad things in my life. His wounds were just too extensive for his little body to recover. Although I know in my heart that this is the compassionate thing to do for him, it still sucks...

I did get another month with him. I selfishly wanted more. Herman was born in our bedroom, seven years ago next month. His mother Maggie had five puppies, all boys. We planned on finding good homes for all of them, but Herman chose ME. He was the runt of the litter, but the one with the biggest heart.

Our lives are truly enriched by our friends, our children, our loved ones. There is something about the love of a pet that touches the deepest part of our soul. Herman will be sadly missed by all of our family and friends.

If there is a Dog Heaven, he will be able to wag his happy tail again today and lick the face of God.

Goodby, Buddy...

Birthday Wish: Healing Herman

Rod Moser

Life is a series of challenging, sometimes sad events, interspersed with happy times. At the end of our days, we all hope that joyous periods exceed the sad ones. I firmly believe that the more someone loves a being, the deeper the pain when the life ends. Statistically, the longer we live, the more likely we experience those losses.

I will be 56 years old in a few days; considered "middle age", assuming I live to the ripe old age of 112. Since I don't think I will, I guess I am on my (hopefully, slow) journey down the other side of that proverbial hill. Personally, I feel young, but I am humbled; and a bit startled, when I see a white-haired man in the mirror.

I am in the 34th year of my clinical career and plan on working about nine or ten more before I transition into semi-retirement. I say "semi", since I plan on working part-time simply for enjoyment. That part-time work will include WebMD if they still want me.

Birthdays have never been a particularly happy time for me, even as a child. My mother never believed in birthday parties, or even gifts for that matter. I did have one birthday party in first grade. I invited my entire class to our basement for cake and ice cream. All the kids each brought me a dollar. As a six year old, having $25 seemed like a fortune. It makes me very sad to think what happened to that money. My mother took it to pay for the party and to buy me some socks. That unbelievable act of uncaring probably sat the stage for my usual birthday attitude.

This year, my wife went all out and bought me some wonderful gifts, including a GPS for the car that I have always wanted. When we got lost on the Southern California freeway system a month ago, she finally understood the practicality. Since I love to cook, she got me a new wok (for the grill) and pan to make scones. I got a cool novelty wrist watch for the kids at the clinic and a statue called The Tickle - a ceramic hand tickling a ceramic foot with a feather. I definitely needed cheering up this year.

If you have been reading the blog, you know that I am desperately trying to save the life of my canine companion, Herman (the Sheltie). As usual, he is lying behind me; on a towel. Herman was run over by the back tire of my truck about a month ago and his wounds are not healing, and are now very necrotic. Last week, the veterinarians recommended euthanasia. So far, I can't do it. He isn't in pain, but he is far from the happy, perky dog that he used to be. I really think the vets gave up on him too easily, so I felt it was up to me to try a few more last-stitch efforts.

If you are eating, or have a weak stomach, STOP READING NOW!

Much to the shock and horror of my office staff, a FedEx package arrived yesterday with a few hundred medical maggots. Yes, maggots. As unorthodox as this approach may be, it is more common than you think.

Medical maggots are referred to as Biological Surgery, and are used to debride wounds of devitalized and dead tissue. What would take a surgeon hours to do under an operating microscope, these little maggots munch away in no time. Hopefully, once this dead tissue is gone, the body will granulate new tissue in its place.

If Herman was a real human, he would be eligible for skin grafting, but for dogs, this is not usually feasible. Herman's wounds may be too extensive for him to ever heal, so I may only be prolonging the inevitable, however, I thought it was worth a try. In the next 48 hours, we will know if the maggot therapy was helpful.

Last night, after my 12-hour shift, my PA wife and I carefully cleaned his wounds and applied the maggots. It was not nearly as creepy as it sounds. They went right to work and wiggled into his wounds. It took about an hour to do this. Herman remained motionless on his back during this entire ordeal. Herman's mother, Maggie, watched patiently. Oddly enough, Maggie's nickname has always been "Maggot".

Finding an effective dressing that allowed air circulation and "maggot containment", and also fits a dog was another big challenge. This is where one must be very creative. After several failed attempts, Herman is now wearing pantyhose over a diaper that was cut in half. He doesn't have a tail anymore, but we had to cut holes for his vital parts. This is then topped with a fluorescent green canine safety jacket. Imagine a lion wearing a leotard.

Now, we wait.

Related Topics:

• WebMD Video: Maggie, the Hospice Dog
• Making a Gratitude Adjustment

Technorati Tags: alternative healing, pets, dog, sheltie, maggots, maggot therapy

Taking It on the Road

Moser

Although WebMD Health Experts are not obligated to post every day, it sort of becomes addicting, even when on vacation.

Over the last eight or so years, I have posted responses from cruise ships in Mexico and Alaska, the District of Columbia, Maryland, Maine, West Virginia, Pennsylvania, Oregon, Idaho, Washington, Nevada (Vegas!), Canada, England, Scotland, Wales, and Ireland, just to name a few places.

When I list all of these places, it appears that I am some kind of world traveler. I attend a lot of medical meetings, and I do like to travel. After 9/11, I don't travel quite as often. I can't remember a time that I didn't take along the laptop.

I have used wireless networks in restaurants, hotel lobbies, conference facilities, and some of the oddest Internet cafes you can imagine. I have sat next to some dubious characters (probably setting up those infamous Internet scams), and waited my turn at the library when my satellite service fails, which is quite often (I won't mention the name, but it rhymes with Mirth Link.). I have even posted from my car outside of a hot link that I found.

I post quite often from my clinic desk (see photograph), between patients, when there are "no-shows," after my 12-hour shift, and of course, while eating lunch over the keyboard. If there ever was a global famine, I could live for several days on the crumbs that I could shake out of my keyboard.

Mostly, I post from my rural home nestled in the Sierra Foothills between Sacramento and Lake Tahoe. My window looks out on the snow-capped mountains, lots of beautiful Japanese maples that I planted, and my neighbor's shack. He inherited the property from his grandmother and "improved" it by building an outhouse-like shack, where he spends the weekends, perhaps writing his manifesto. I like to keep an eye on him. We call him "Ted" and his shack, "Ted's shed." He likes to burn stuff; not a good pastime when you live in a high fire risk area.

When my home network is functioning, I can post from my vegetable garden, from the garage, or sitting out in the grass alternating between typing and dog-petting. I won't show you a picture of my home office, but I can describe it to you...

I enlarged my desk with a huge sheet of oak plywood (finished nicely, of course) so that it will hold the stacks of papers, bills, and stuff that I should throw away. My computer is about six years old. I would like to replace it, but my Internet connection is so unreliable that I would be like having a Ferrari just to drive around the yard. My laptop is newer, but not by much. As long as they work, I am fine with them.

I have three printers (I like to take digital photographs), a copy machine, two scanners, a paper shredder, and a television. I threw my fax machine away, since it wore out one day when a real estate office accidentally printed my fax number on their business cards. I had just added a whole ream of paper, too.

Behind my desk, you will find three bookshelves filled with my reference materials, two file cabinets, and a big, glass case that holds my lifelong collection of antique medicines, including my award-winning collection of antique laxatives. All of these (and more) will soon be on permanent loan to the new Gold County Medical Museum when it opens in the fall.

The floor (carpeted, I think) is my desk extension and axillary file. There are several piles of neatly stacked papers that do not fit anywhere else. In a cleared space by my desk, you will find my dog, Herman. He has been my constant companion since his birth in our bedroom seven years ago next month. Herman's mother, Maggie, is downstairs looking out of the window, hoping to see our seasonal coyote attempting to get another one of our cats.

I don't know what I am going to do without Herman. He was in a terrible accident about a month ago, and is slowly dying from his injuries. I was told on Friday that he needs to be euthanized; he will not recover from his wounds. We have done everything we can to try and fix the damage, but there is about a 99% chance that I will have to make that painful decision soon. While I know it will be the kind and compassionate thing to do for him, I have to come to terms about it myself.

This is why I am posting on the Ear Disorders Board and writing this Blog at 3 AM. I can't sleep and there is a sad rain outside. It even got my face wet...

Related Topics:

• Coping With Pet Loss
• 5 Ways Pets Can Improve Your Health

Technorati Tags: pets, dogs, travel, health-and wellness

The Baby Whisperer

Yesterday, I had a flood of new babies in my practice. By noon, I had seen four new babies; average age 3 days. Our hospital nursery is full. I wonder what was going on nine months ago. Maybe there was a power outage? Or, perhaps there was nothing on TV.

Having spent most of my career in family practice, I had my share of newborns, mostly since I took care of their mothers. However, when you limit your practice to pediatrics, every day is baby day, and I love it. Seeing those proud new parents (and grandparents) makes my day unbelievably pleasurable.

Babies cry. That is what they do. They cry when they are hungry or gassy, or they just cry for no particular reason. They are not necessarily unhappy about their entrance into this world, although they must be a bit puzzled. A few days prior, they were floating and bobbing around in warm amniotic fluid, upside down, like little astronauts. Suddenly, they are squeezed into the light -- into a world of loud noises, strange shapes, even stranger people, and of course, odd smells. C-section babies must really get a shock. Their birth would be like someone removing the roof of your house, reaching in, and pulling you out!

It is perfectly normal for healthy newborn babies to fuss and cry about two to three hours per day, continuing to hone those crying skills, reaching a peak around age six weeks. New parents are always looking for some medical explanation for this normal crying. There must be something wrong.

Babies like to be held and cuddled. Babies like to nurse or suck on a bottle/pacifier. Babies like to be warm (but not too warm). Babies like to be stroked and touched. Babies like to be snug and feel safe. Babies are not particularly fond of being flat on their backs most of the day. This is an unusual position for them.Remember, they were upside down a few days ago!

Because babies who sleep on their backs are less likely to have sudden infant death syndrome (SIDS), parents have become absolutely fanatical about this. Although they do give their babies "belly time," they worry about it, even when babies are old enough to flip over by themselves. When they are old enough to flip over, they are old enough to sleep anyway they like. One new mother in my practice hadn't had a good night's sleep in months. She would watch the baby on the monitor. As soon as her baby would turn over on her stomach, she would rush in and flip 'em back on the back. I told her it was okay just leave him be now, otherwise she might continue to do this into his teenage years.

When I entered the examination room this morning, a new mother was desperately trying to comfort her crying newborn. Grandmother was offering suggestions, but nothing was working. She tried nursing her, but she wasn't hungry. After I finished taking the history, she put the baby on the examining table, on her back, in preparation for the exam. The crying continued.

"Would you like to see a little trick?" I asked.

I picked up the baby in her soft blanket and gently laid her over my arm, like those lions in Africa hanging over a tree limb. I held her close to me and rocked her just a bit, while stroking her little face. Within seconds, the crying stopped. In less than a minute, she was sleeping and the room was quiet and calm again.

"Are you some kind of Baby Whisperer?" the mother asked.

That was probably one of the nicest compliments that I have ever received.

Related Topics:

• WebMD Video: Babyproof Your Sanity - 6 Tips for New Parents
• WebMD Video: Breastfeeding Basics

Technorati Tags: babies, crying, parenting, SIDS, medical practice, health-and-wellness

No Shows - Failure to Make Your Appointments

No-Shows are a double-edged sword in the medical world. An appointment was made and a slot was designated for your arrival. Other people who requested that same appointment time were turned down. You did not call to cancel your appointment; and you did not show up. The day after Easter I had three No Shows in a row; two for physical examinations. The double-edged part is that I also had time to write a Blog about it.

Everyone makes mistakes. Everyone forgets appointments. Personally, I have developed this short-term memory issue over the last few years. (See "Rinse, Lather, and Repeat"). Sometimes, there are unusual circumstances that result in missed appointments, but most of the time, we simply forget. We are human.

We do have frequent-flyer No Shows in our practice. Each incident earns a red "No Show" stamp on their chart. Now that we are going to Electronic Medical Records, those No Shows are not as evident as before. We forgive the first one; send a nice letter when it happens a second time, a less-nice letter for the third time, and finally, after repeated No Shows, a letter of dismissal from our practice. This last letter is rarely sent. It is interesting that the same woman that repeatedly misses a doctor's appointment will never miss a hair appointment.

Because I work in pediatrics, I can't really punish children because their parent may be an airhead. Parents and children do get over-extended and over-stressed, so I tend to cut them a lot of breaks. Because I have missed a dental appointment this year and a several meetings, I tend to be very forgiving.

I am one of the few medical providers in our practice that will see patients that are late (less of an infraction than not showing up at all) and see patients that are Walk-ins. Diseases rarely show up on any type of schedule that you can anticipate, so if a sick child is brought in, I see them, no matter how busy I am.

Looks like I just had two more No Shows. This is a new record; five out of 15 patients this morning chose, for whatever reason, not to call, cancel, or show up. The weather is nice; kids are off school today. Maybe traffic was bad getting out of Disneyland yesterday, I really can't say. In addition to having time to blog (quite unusual on normally busy Mondays), I cleaned off my desk and emptied a box of crap that I brought from home six years ago. I discovered that it was still crap (just older stuff now), so I threw it away. I now have a top on my file cabinet, creating more room to put more stuff.

I hear a child screaming, so I think a patient is finally arriving. Fifteen-month olds scream for any reason. They hate medical people. They hate scales. They hate thermometers. At least there is only one of them. One day, I had triplet 15-month olds for physical exams and immunizations. That experience worsened my tinnitus, for sure.

If you have been a No Show in the past, your doctor may forgive you; once or maybe twice. Next time, pick up that phone and call. You can even lie and make up some elaborate excuses. We still won't believe you but we do enjoy those stories.

Related Topics:

• Getting the Most from your Doctor's Appointment
• WebMD Video: Wait-Free Doctor Appointments

Technorati Tags: medical practice, medicine, time management

Seasonal Allergies: What You're Itching to Know

Photo Credit: J. Bowman

When you practice medicine in Northern California, often referred to as the Allergy Capitol of the World, you realize there are two distinct seasons: Disease Season, and Allergy Season. This year, like many years in the past, they ran together.

All winter long, we battled colds, influenza, and the complications they occasionally cause (ear infections, sinus infections, bronchitis, pneumonia, etc.). Colds are due to viruses, and of course, there are no shortages of those. Adults with normal immune systems tend to get about 2-3 significant colds per year. Of course, that is assuming they do not work with children or have questionable hygiene practices. Colds enter the body primarily through the nose and the eyes (the eyes have an anatomical connection to the nose), not through intact skin. Dirty hands rubbing or picking a nose, rubbing the eyes, or being in direct line with a cough or sneeze is how we get most of our colds. Additionally, we catch colds from freshly-contaminated surfaces.

Colds cause runny noses. Allergies cause runny noses. Colds cause coughing. Allergies cause coughing. So, how do we tell the difference ?

In children, colds can cause fever; allergies do not. Allergies cause itching; like an itchy nose or itchy eyes; colds do not. They both can result in coughing. To complicate matters, there are no rules in medicine that state you cannot have a cold AND allergy symptoms at the same time -- the Double Whammy.

Staff Photo

In Northern California, trees are dropping pollen, flowers are blooming, weeds are growing, lawns are being mowed, and dirt is in the air. Of course, if you live in Kansas, you are "lucky". All you have is snow to plow. This week in the clinic, it was a never-ending dance of allergic conjunctivitis (red, itchy, watery eyes), runny noses, coughing, sneezing, hives, eczema outbreaks, and wheezing. The asthmatics were out in force, puffing on their inhalers. Soon, we will see children and adults needing emergency room visits or admissions for uncontrolled asthma.

Working in pediatrics, I get my daily doses of disease exposures. Fortunately, my constantly-challenged immune system fights off most of them. A few Frankenviruses do get me down from time to time. I recently finished a course of antibiotics for a sinus infection. On the allergy side of things, I am not really bothered. I was allergy-tested in the past. After 200 skin tests on my back, it was discovered that I was allergic to...nothing (except bee stings). This year, I am not so sure. After mowing the lawn earlier this week, I started to wheeze. I was having an asthmatic reaction for the first time in my life. Something out there, perhaps the one inch of yellow tree pollen on the ground, did not like me. Even at my age, asthma or allergies can simply start. Compared to some of my little patients, my symptoms are nothing.

Our local allergies/pulmonologist does a booming business. If you have any investments in the pharmaceutical industry, you may want to shift your money into those companies that sell allergy products, like Claritin, Singulair, Advair, or albuterol.

Inhaled corticosteroids (also known simply as "steroids") are the mainstay of asthma management, yet many people are reluctant to use them. Low-dose, inhaled pharmaceutical steroids often get lumped with those abused muscle-building, rage-causing, home-run hitting anabolic steroids. They are different. Asthmatics will excessively puff away on those rescue inhalers, like albuterol, but yet they are reluctant to take a medication that would actually prevent their asthma attacks. A controlled asthmatic rarely needs albuterol, although they should have one on hand just in case.

Last night in the clinic, I saw a teenager completely covered with hives (urticaria). She has been itching all day. It had progressed to a nice case of puffy eyes and fish-lips. She was not a happy camper.

"Did you give her any Benadryl?" I asked.

"No, I thought I would wait so you could see her hives."

I don't really need to see those hives. I believe patients when they tell me they had a sudden onset of itchy welts all over their body. When you get hives, for Goodness Sake, please take an antihistamine! Don't wait around all day for it to get worse.

Allergy and asthma management requires that the patients and their families be educated. You absolutely cannot depend 100% on your medical providers to control these symptoms. You need to take an active role. People must know the medications they are taking, and why. They must learn to recognize their allergic triggers and try to avoid them. And, they must be proactive by taking preventative steps early in the allergy season.

Like many of life's afflictions, allergies and asthma are not curable, but they are infinitely treatable and/or preventable. There are some wonderful medicines out there that will make your life safer. Uncontrolled, asthma can be a killer. Many years ago, my PA wife was working with indigent children and newly-arrived immigrants. She would go out to them in a specially-equipped COW -- Clinic On Wheels. The driver/medical assistant was an asthmatic, and the father of two little children. We were saddened to find out that this healthy, young man passed away from an asthma attack called status asthmaticus.

No one really wants to take an array of expensive allergy and asthma medications, but they can save your life.

Related Topics:

• Allergy Vaccine: 6-Shot Cure?
• Check the Local Pollen Count

Technorati Tags: allergies, asthma, pollen, allergic asthma, hives

Friday the 13th and Haircuts

Is Friday the 13th really unlucky? I hope not, since I have a lot of the things to do today. Over the years, I do not recall any specific crises on that day. Patients are not coming through the door with impossible diagnoses, or dropping over in the hall. While I am not superstitious, I am worried about this upcoming one, but not because of patients in the clinic.

I called for an appointment to get my haircut this AM by my usual barber, Manuel, and found out that he retired since my last haircut three months ago. Apparently, he had another heart attack. I have been going to him for about seven years, after my former barber, Ed the Mormon, retired with back problems. I have been going to Ed for about 15 years, and he was the husband of our front desk czar, Barbara. I loved both of them dearly. I even tried to talk Ed into cutting my hair at his house, but no dice. Ed retired completely and will spend his final days playing his jazz saxophone.

When I called to get an appointment with Manuel today, the other barber answered. I don't remember his name, but I have an appointment to get my hair cut on Friday -- Friday the 13th. During the entire seven years that I have had my hair cut by Manuel, this other barber was always reading the newspaper. I never saw him cut anyone's hair. That concerns me. He seemed quite eager to book that appointment. His enthusiasm has me worried.

My wife spends hundreds of dollars (probably a thousand!) on her hair each year. I have been told that women do that. Guys just get their hair cut; no frills. I was shocked one day when Manuel whipped out a neck massager and went at it. It felt good, so after the initial shock of this new service, I just let him do it. That is about as high-tech of service one can expect in a small town. I have always felt a little weird when the barber shampooed my hair, so I tend to show up with a wet head, fresh from my shower. I am going to miss Manuel.

As a child in rural Pennsylvania, we had two barbers in town: Shorty and Nolan. When Shorty raised his prices to a dollar and a half, the boys switched to Nolan. Nolan only charged a buck and we kept the other fifty cents. The barbershop in Fairchance, PA was a lot like that barbershop in Mayberry. Guys would be sitting around, talking, reading magazines, and telling dirty jokes. Some of the guys would be reading men's magazines filled with naked pictures that Nolan kept in the back. Young guys tried to keep a low profile and melt into the furniture. Soon, the men would forget kids were there and the conversations would change. This was our sex education class.

My first glance at a real picture of a naked woman (or is that a picture of a real naked woman?) was at Nolan's Barbershop. It was a slow day. Jim King and I were hanging out, trying to smooth-talk him into letting us see those magazines. I guess we were about thirteen years old. Nolan finally gave in and brought out an old one. He said we could have it. For the next year or so, that magazine was viewed by more of our friends than you could imagine. We had a shrine built for it in our "cabin" and it achieved the status not unlike the Magna Carta or the Declaration of Independence.

For the first twelve years of my life, I either had a buzz top or a flat top. My mother (Incidentally, she was born on Friday the 13th) felt that a buzz haircut was a better deal since it lasted longer and didn't require that butch wax that melted on her pillowcases.

As a 50ish adult, I am really not that picky about my haircut anymore, but I am a bit anxious about this new barber's skill. It took Manuel several years to get it right. Ed always tried to give me a Mormon Missionary haircut or a flat-top again. I have no idea what is going to happen with this new guy. Haircuts are $20 in our town now. Nolan would have cut my hair twenty times, or about ten years worth, for that price and the magazines were better. No neck massage, though.

Related Topics:

• The Psychology of Superstition
• Haircuts 101: A Guide for Men

Technorati Tags: superstition, haircut, fridaythe13th

Phone Messages Lost in Translation

I don't know why I even have an answering machine on my phone. At least once a week, I get one of these:

The quiet-talker: Someone with a mouse-like voice that whispers the message into your phone. This often requires you to play the message back repeatedly at full volume.

The fast-talker: The person that gives a relatively clear and detailed message up until the phone number; where it is said rapidly and with a slurred voice, not unlike an auctioneer. Thank goodness for Caller ID, unless of course, they have blocked their number.

The foreign accent: One of my best friends is from Egypt. He has lived in the U.S. for over two decades, but yet his accent is so strong on the phone, that I swear he is speaking Arabic. I have yet to be able to interpret his phone messages.

The long-talker: My wife's friends love to fill up the entire buffer of the digital answering machine with their one message. These messages can literally last ten minutes or more. When my wife calls them back, they will repeat their message.

The short talker: "Hey, it's me. Call me back." These are usually from my friends.

The cell phone dropped calls: "Guess what? My wife just had a (blank) yesterday! Give me a call right away. I am at (blank). Okay, bye."

Written messages - Lost in Translation:
Several years ago, I had a sweet, young receptionist in our family practice clinic that clearly missed most of her English classes in school. Her spelling was absolutely terrible. Her name is Renee. Maybe you know her? I saved some of the more interesting pink, written phone messages that I would like to share with you. These are the entire, actual messages that I received (I still have the originals to prove it):

"Patient has a bowl on the outside of her vagina; has a question on it."

"Coughing and weeping three days now."

"Worm again. Please advise."

"Needs Rx for Quail. Found some bugs."

"Pulling on ears for two days. Also has a horse voice."

"Wants to come."

"Baby pick up dog stools and put them in her mouth. Mother is worried about worms."

"Child pushed a One-A-Day vitamin up her nose this AM."

"Has termites and going crazy. Wants a tranquilizer."

"Wants to be seen for Vag. Pollocks"

"Boy Scouts of America (not asking for a donation)"

"Hell"

"Puss in eye."

"About medication. Deceased."

"Passed away Tuesday morning. They were told she left instructions with you to dispose of her remains."

"Bitten on the hand by a Sea Gull after leaving the clinic this morning."

"Feels rotten."

"Wants referral to a Gym. Wants to get pregnant. Please advise."

"Has appt. for pap smear. Wants to know if she can have sex before her appt. Call her at work. Ask for the restaurant."

"Brused in the croach."

"Call mother. Her son, Jason, is either ignoring her, or is deaf."

"Our bird is sick."

"Medication makes her feel like a zombie."

"Thinks she swallowed a staple a few minutes ago."

"Side affected with BC pills."

"Wife called. Want to ask you about a gravity machine."

"Mother wants to know if it is okay for Melissa to wail until the 21st."

"She hasn't been able to go #2 for two weeks. Stomach is blowed. She would like to talk to you."

"Was stabbed in neck by sister with ink pen. Mother concerned."

"Pumps are getting worse. She has a sore on the tang."

"Regarding her female parts."

"Wants to know what she is supposed to do. She called yesterday about trying to get pregnant."

"Black tongue. Piece falling off."

"Billy Rubin. 10.5"

"Need to know his blood type. He is going on mission for the Moron Church."

"Needs results of school samples."

"Has infection or fucus on both arms."

"Cave in on breast for one month. Breast odd shape."

"Access on bottom. Has a big head on it."

"Sandra canceled Willy's appt. Didn't want to waste gas."

"Re: Test for pubic hair."

When you leave a message for your medical provider, please be advised that there may be something lost in translation. About 25 years ago, my wife and I were teaching Self-Care classes for the community -- showing people how to use common medical instruments and to take a more active role in their own medical care. There was a story about our class in the newspaper that was of great interest to California Govenor Jerry Brown. He called our office to get more information about the class. Not only did they not put the call through to me, they took a routine message and spent the entire afternoon trying to find his "medical chart". I finally got the message a few days later with the "unable to find chart" stamp on it. I never did get in touch with Governor Brown, so he missed the class.

Related Topics:

• What's Your Humor Style?
• WebMD Video: ER Communication When You're Deaf

Technorati Tags: healthcare, medical practice, humor, communication, telephone, message

Man's Best Friend in Surgery

Photo Credit: Rod Moser

I have had dozens of dogs in my life and I must say they were all special in their own ways. Unlike humans who can be judgmental, dogs just love you. Herman is my friend; my dog; and he was seriously injured today. Herman was the runt of the litter of five puppies born to my other Sheltie six years ago. I fell in love with him immediately and would not let him be adopted out like his four brothers. He was extra-special.

I wrote a post about Herman a few months ago when he decided to eat an impressive amount of sand-covered cat poop, resulting in an intestinal obstruction. I guess he was bored with his dry dog food. Just like our children, there are some dogs that just seem to get in trouble from time to time.

Shelties are herding dogs; perhaps that is one of the reasons why he is always at my side. He has been extra clinging since we left him with our son for ten days when we went on vacation. When I am posting on WebMD, he is at my feet. When I am sleeping, he is on the floor by my side of the bed. When I am working in the yard, he is always there to protect me from potential hummingbird attacks or from being bothered by our cats. Even though Herman is a different species, he is my friend. He listens when I talk and he never interrupts.

Today, he got too close to my truck when I was driving down the driveway. His very bushy tail and rear-end was run over by my right rear wheel. I had no idea he was following me that close. To hear the cry of an injured pet causes your heart to sink.

I ran for my first-aid kit and applied a dressing to stop the bleeding. His tail was nearly ripped off, but he sat still as I tried to help him. He licked my hand.

My wife held him as we rushed him to the emergency vet clinic thirty miles away. We stayed with him until he went into the OR, and have been waiting for the last three hours to hear from the surgeon. We called three different times to check on him, but he is still in surgery. The veterinarian is well-qualified, but even she had never seen an injury quite like Herman's.

The veternarian staff directed us to a small room with a comfortable couch and subdued lighting. We were told that the veternarian wanted to speak with us. I knew in my heart, this was the Death and Bad News Room, so I told the staff member that I would rather wait somewhere else. She was surprised that I knew this was the "death room". They had us sign the estimated cost forms and ask us to sign if we wanted him resuscitated in the event he had a cardiac arrest.

I know it may seem silly to worry about your dog like this, but after the children have grown up and gone away, your pets become your children. While I am not one of those odd dog-lovers that pamper their pets, I do care for them a great deal.

I know that I will not see him wag his tail again. The tail must be amputated, but I pray the rest of him will remain intact. He will just have to learn to wag his butt. If the crush injury caused nerve damage to his urinary or anal sphincter; or if he becomes paralyzed, he will have to be put down. I have had to do this for several of my pets over the years; most recently our other 17 year old Sheltie. It is never easy but it is always the compassionate thing to do when all else fails.

Follow-up: It has been a week. Herman survived over two hours of surgery and we picked him up the next day. He is shaved from the mid-back down, making him appear to be a lion. Perhaps this is symbolic because his little heart is like a lion. His wounds were covered with a pink, girlie dressing. Of course, he had no tail. We are so happy that he survived this frightening ordeal. Hour by hour, and day by day, he seems to be doing better. We have been nursing him back to health, hand feeding him, and carrying him for the last week now.

He has returned to his spot by my feet as I type this update. I had to carry him up the steps. He is still very sore, has a difficult time standing, and doesn't sleep very well. He continues on the antibiotics (more expensive than the ones that I took last time) and pain medications. He stays in visual range of me at all times and requires a lot of petting. There is no tail to wag, but I know he is phantom-wagging.

The surgical drains were removed a few days ago. Today, he walked around more and even tried to chase the cats again. For dogs, these are good signs. I think my friend is going to make it. He just licked my hand.

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