Monday, May 31, 2010

A Vet Pushes His Dependency Model



This video is typical of how veterinarians are now selling a dependency model.

The message is not "if your dog is sick we can cure it." The message is that their wallet is empty and they you need you to fill it!

Watch the video.

This vet starts off with a generalized message about the importance of vaccines. He then goes on to note that he has been in practice for 30 years and never seen a case of distemper.

Does he explain why distemper is so rare these days? No he does not.

So let me explain it: Vaccines are good for life.

After that first round of vaccines given in Year One, your dog never needs a vaccine again other than a single rabies shot every three years.

And guess what? You can skip the vet for that rabies shot too.

You can get a rabies shot for $10 (complete) down at your local shelter, and without an $80 office charge tacked on to boot.

Notice that this vet never mentions any of this. He never says vaccines are good for the life of your dog. Instead he shilly-shallies around before finally changing tack:

"Bringing the dog in for vaccination is not about vaccination, but about bringing the dog in for an exam."



Eh? So vaccines are not about vaccines? They're about "exams"??

Bullshit.

Vaccines are about vaccines, and let's not get confused about that, eh?

Routine office exams are about bill padding and selling unnecessary medical services.

This vet says you need to bring in your dog twice a year "to see what's going on."

You can skip that.

I can tell you "what's going on" if you are bringing in your asymptomatic dog to the vet twice a year: A whole lot of junk billing.

For starters, every "well dog" visit is going to cost you $80 or more just for crossing the threshold. Nothing done at all, so far.

As I have noted in the past, however, once a veterinarian gets you through the front door, their staffs are trained to start pushing nail trims (a charge), useless Lyme disease tests for asymptomatic dogs (a charge).

They may suggest a "prescription diet" (which they just happen to sell), and they will try to toss in a "booster shot" every time they think they can get away with it, and never mind if it is medically unnecessary.

Your dog will be tested for heartworm (even if it is under 6 months old and cannot possibly get it), and you will be given heartworm pills to dose your dog with every month, even if it's a Minnesota winter outside.

If your dog is spayed or neutered, there will be a push to keep the dog overnight so an additional charge can be tacked on to the bill. And, of course, you will want to get a stool test, right?

This is how it goes in the veterinary business these days.

What is being sold here is a "dependency model"

Dependency model veterinary practices generally have vets who make vague and mewing sales pitches like the one being given here.

Their goal is to get you in the door multiple times a year so that
pushy receptionists and "vet techs" can run through well-rehearsed scripts designed to get you to buy goods and services you do not need and did not ask for.

One way to get you in the door is to serve up a dish of confusion when it comes to vaccines.

For example, listen to this vet's line about how there might be different vaccine protocols for "different rates of exposure"?

What's that mean? I have no idea. It is complete nonsense.

Remember this same vet just said that in 30 years of veterinary practice, he had never even seen a case of distemper.

So much for "rates of exposure!"

In fact, rates of exposure has nothing to do with vaccination.

I am fully vaccinated against measles, mumps, rubella, and a whole lot of other diseases. I do not fear catching these disease when I ride subway cars filled with recent immigrants who have just entered America from God knows where.

They can all have measles, mumps and rubella, but I am not going to catch it because I was vaccinated as a child more than 45 years ago! In fact, a little exposure to a live virus is a good thing for my immune system, as it switches on my T-cells and gives them a brief workout.

What about dogs?

The same holds true for them.

The vaccines they get in Year One last a lifetime, and any dog walking through a park is going to have his immune system challenged, to positive effect, by latent diseases on fence posts and in the soil. No problem there at all.

So what is all this vague talk about "lots of different options?"

Simple: this is the windup a vet gives when he or she is sizing you up for a big bill.

And here's the pitch. It comes right out of the marketing literature and bill-padding training camps (more on them later) being funded directly by Big Pharma:

"The important part is to get that animal in and have him examined twice a year.

Every year in a dog's life, they say, is seven years in human years, so every year you are going through seven years.

It's not like you want to go in every year; you want to go in twice a year and have him examined."



If your vet tells you this, leave immediately and never come back.

Here's why: your vet thinks you are an idiot. You have just been insulted, and you should be pissed off about it!

A year is a year. There is not such thing as a "dog year." That's a story knocked up for a 7-year old to explain why his Cocker Spaniel is an adult at age 5, but his 7-year old self is not.

Question: Do you think this vet tells hamster-owners that because their animals live for only three years, "every month in a hamster's life is really two years in human years, so you need to bring in your hamster every month just to see what's going on."

Nope. And it makes no more sense for a dog.

A twice-a-year well-dog visit? Forget it!

Here's better advice: Between the end of your dog's first year, and the end of its fifth year, your asymptomatic dog does not need to see a vet at all.

At the age of five years, go in and get your dog's teeth cleaned, if you want, and do it again at age 10. In between, simply brush your dog's teeth once a week with human fluoride toothpaste and an old toothbrush retired from your sink.

Spend time on your dog, not money. Brush his coat once a day and make sure you run him thin not fat. Check him over for ticks and lumps. If your dog looks fine, and acts fine, it is fine.

Your leashes should be worn from use, not the magnetized swipe strip on your credit cards.

For the record, "Pet Doctors of America," is nothing more than a local veterinary clinic near Jacksonville, Florida.

So why the fancy name that suggests it's part of a national chain or an industry-wide trade association?

Simple: If you are a veterinarian pushing medically unnecessary goods and services, you need to claim as much authority as possible.

"Pet Doctors of America," I think we can agree, is a pretty big claim for a brick storefront located in a strip mall next to a Pappa John's.

Aside, from the grandiose name, however, this veterinary office is unexceptional in its sales techniques.

Selling medically unncessary services, price-gouging on meds, and bill padding is now normal in veterinary care.

Can you still find an honest vet?

Of course, but you're going to have to look.

The industry is changing rapidly and, in the field of ethics, at least, the change is not for the better. Support honest vets with your honest dollars. Stop feeding the liars, thieves, cheats, and conveniently ignorant.

Notions of Time and Reward Shape Culture




This is a terrific video. Watch the whole thing for both form and content. Nice!
.

This Man Is Better Than Cesar Millan (so he says)



This man says he has a Honda Ruckus scooter, and he is looking for a "celebrity client" so he can show the world that he is a better dog trainer than Cesar Millan.

He says this video tape is proof of his awesome dog training capabilities.

He also says "Sign me to a book deal, or someone else will."

Excellent. Perfect. Crazy as as bedbug.

Does Pfizer maker a pill for this?
.

Waiting for Guest


Waiting for Guest. A cup waiting to be
filled with the sweet tasty drink. Oh wait
Guest first of course.
Acrylic on 10x12 panel board.

No Longer Available

Sunday, May 30, 2010

Many Hands Make Light Work



This is a street camera in China.

A thief on a motorcycle tries to steal a purse.

Watch what happens next!
.

Roof Tops

Roof Tops is a painting of a skyline with bold colors
not seen in the skylines of America. Or should I say I haven't
seen any in rural Alabama.
8x8 acrylic on panel board.
This painting is for sale.

Saturday, May 29, 2010

Day +10 RELEASED!!!!!!!!!!!

Friday, May 29, 2010, 10 days after my stem cell transplant my body recovered to the point that it was deemed ready to be sent home. My mind and spirit got to come along too, but they've got a lot of catching up to do. My emotions are all over the place right now.

Throughout Thursday night I never spiked a fever. My first temp check of the day on Friday registered at 98.6, an exactly normal temp. It stayed that way for the rest of the day. I was physically feeling a lot better, just beyond tired. I really never slept more than 4 or so hours a night for an eight day stretch and sleep was broken all the nights of the chemo infusions the week before so it was safe to say that I was sleep deprived.

The attending doctor and the team of residents and interns came in to see me in the morning and told me that my white blood cell count had completely recovered – 7.5 (from 0.1 on Saturday) – my immune system was back. They told me that as long as I could "stay cool," meaning no fever, that they could possibly discharge me that evening or the next morning at the latest.

I was kind of in shock.

"Would you like that?" he asked.

"I would love that," I said. "Even tomorrow morning would be fantastic."

Before they came in I was poking around my soggy corn flakes in a plastic box mentally preparing myself for starting the course of steroids later that morning and preparing myself for another three days of hospital food and IV pole tethering.

Well, I did "stay cool" all day in fact and because I never spiked another temp, the steroid regimen was never needed. My body embraced my stem cells without a problem. The persistent fevers were just chalked up to my severely compromised immune system - something was going on inside me that it couldn't fight but as soon as those stem cells birthed enough white blood cells at the direction of all those Neupogen shots they started taking care of business and got me back to normal temp.

Craig was there with me for the day and we worked on some projects together to pass the time. I received some potassium and phosphorus repletions to bring up my levels and continued on my oral antibiotics. They still had another fecal sample out for testing so the contact precautions were back on until anything was ruled out so I wasn't allowed to leave the room and everyone in it had to glove, gown and mask – including Craig. I really had no expectations of going home that night.

Then all of the sudden at about 3pm a resident and an intern came into my room and said that they were going to be sending you home. The fecal matter tests came back negative so the precautions signs outside my door were taken down and everyone ripped off their blue paper gowns. They explained that since my counts were back to normal, since my feveral pattern had subsided and since I had no other symptoms that it was safe to say that my body had recovered from the high-dose chemo and stem cell transplant.

I don't remember what I said back but the doctors looked at me and said: "Does that sound good? Would you prefer to leave tonight?"

I just didn't get it.

"So I can go home home, not the hotel? I can eat what I want, drink what I want, go out in public?"

Craig said that as I spoke my voice was so shaky and he could visibly see my chin trembling. He had to keep stepping in to ask questions and talk for me.

They told me that I still should avoid big crowds and stay away from anyone who is visibly sick as I continue to recover. Dr. Cooper and his nurse Erin who saw me later told me that my only restrictions were "no sushi and no digging in the dirt for a while" and that they'd see me on Tuesday.

The doctors told me that they'd write up my discharge instructions and write me a prescription for Acyclovair, the antibiotic I'll continue to take three times a day for six months. As my platelet count was borderline they also wanted to transfuse me with one more unit of platelets before I left just to be on the safe side. They also scheduled me to return to the clinic on Sunday for more bloodwork and any other transfusions as needed. Then again on Tuesday for the same, a breathing treatment to prevent PCP pneumonia and to discuss the rest of the follow-up care.

They left and Craig says to me: "You looked like you were going to cry."

I responded by starting to cry. I was just so overwhelmingly relieved and completely stunned that I made it through. It felt exactly like sky diving when I was 18 though instead of the amazing adrenalin of that free fall, this had been a free fall from hell filled with fear, sadness, confusion and hurt. I jumped out of the plane at 13,500 feet with a little Australian man attached to my back. we were free falling through the sky at 120 miles an hour for one solid minute of pure energy rush. Then together we pulled the cord, the parachute released and the abrupt change in motion was so harsh. I remember the harness around my upper thighs locking so tight against me and our bodies wrenching with the force of the parachute stopping our free fall as it felt we being yanked upward.

When I heard that this proverbial free fall was over, everything around me stopped just as suddenly. It was the abruptness that was the strange part. All of the sudden it was over. I was going from not being able to leave a room or to move my bowels without telling anyone to complete freedom to do whatever my body could handle and complete release to go and start the lifetime healing process. I can only hope that what's to come will be just as beautiful as the slow, gentle, breathtaking parachute descent I took from the sky to a field of grass 10 years ago.

I did not have much to say on the ride home. I was just so happy to have the windows down and the breeze blowing in. We stopped at our favorite pizza place for the Little City special - chicken, melted leeks and artichokes galore. As we waited for my prescription to be filled, we ate it in the car with the windows rolled down. We parked it by a nearby restaurant with a patio that had a guy outside singing and playing guitar. We savored the pizza and listened as he sang U2's "It's A Beautiful Day" agreeing with every sweet lyric.

Then it was home where I inhaled the familiar scents, took a long hot shower to get rid of that lingering hospital film and climbed into bed spreading out in the glorious soft sheets that don't scratch and pillows that are not blue and rubber.

Here I am 11 hours of sleep later with a much clearer head and holding a lot of pride. Things aren't perfect. I'm still very weak, sore, bruised and battered with a persistent cough and chest tightness but I'm on the sweet descent. I'm going to take things slowly and try to decompress and grapple with everything that just happened. I know this will take a long time, but I am so excited for so many good things to come. Most immediately I look forward to a Memorial Day weekend of sun, fresh air, parades and barbecues.

Smiling and at peace.


Pfizer, Pfrauds and Pfools


Profits leap with price-gouging, upcoding, and medically unecessary products!


Yesterday morning I booted up the computer and got an unsolicited full-on email screed from someone I did not know, who had never communicated with me before.

Mark Tye wrote:

You are pretty quick to generalize an entire profession with your loose OPINIONS. You have described less than 10% of the veterinary profession in your rant. Most veterinarians are honest hard-working people who give away way too much, work way too long, for WAY too little.


Eh? Who was this person, and what was he on about?

From reading his stream-of-consciousness email (it went on for several paragraphs), it appears he had just stumbled on a fact- and link-filled post on this blog called Veterinary Trade Says It's Time to Rip-off the Rubes.

Ah! Good. Glad someone is reading the internets!

Mark Tye, of course, called me a pinhead and an ignorant but provided no links and no facts to back up his own ... (wait for it!) ... opinion.

I had provided links to trade publications, documented pharmacy kickbacks to trade associations, and provided PowerPoint instruction sheets from the industry on how to price-gouge, upcode and suggest the medically unnecessary. Most readers of this blog know I am not short of evidence!

And what did Mark Tye have to support his contention that all was sweetness, light, and high moral fiber in the world of veterinary care?

Not. a. thing.

Nor did he explain his own passionate interest in the subject matter at hand.

Much amused I fired back a short note:

Why don't you Google my name and "pharmaceutical fraud" and see what you come up with?

Good luck on your travels. You are clearly very new to the show.


Not smart enough to take a hint and leave well enough alone, Mark Tye fired back.

I have forgotten more about this industry than you know. Why don't you go spend a few years (or 10) getting to know something about the people that make up this industry.


Much amused I fired off another email:

Why don't you tell me all about yourself?

Ten years! Wow. I am floored.

And you have a hotmail account too!


Yes I was being a little sarcastic.

I have spent a little more than 10 years in health care, and a little more than 10 minutes in the world of dogs!

And a hotmail account? Hillbilly, please!

Who was this fool?

A few seconds after asking the question, I had the answer, and I nearly spilt my coffee I was laughting so hard.

Whoo-ee!

I fired off a short email to Mr. Tye:

Never mind. I found you.

Area sales manager at Pfizer Animal Health in Texas for 6 years.

You think that's a lot of experience??

Formerly a recruiter at Matrix Resources and a sales manager at Ed Kellum & Son.

Graduate of Oklahoma Baptist University.

Not much.

Shall I find out what you sell, and write about how you sell it?

Pfizer is a shit company that just got nailed for the largest criminal and civil fines in U.S. history.

Google my name and Pfizer, and see what you get.

You still want to play?


A Pfizer Animal Health rep is lecturing me about health care ethics?

Priceless.

For the record, Pfizer was nailed last year for the largest criminal and civil fraud charges in U.S. history.

As I told Reuters at the time, "What you see here is a company which essentially has a culture of corruption."

And it's not like Pfizer has only been nailed for fraud once, is it?

Along with record fines for illegal marketing and illegal kickbacks which were paid to increase the sales of Bextra, Pfzer has also been nailed for illegal promotion and/or kickbacks for Geodon (an anti-psychotic drug), Lipitor (a cholesterol drug), Norvasc (an anti-hypertensive drug), Viagra (an erectile dysfunction drug), Zithromax (an antibiotic), Zyrtec (an antihistamine), Zyvox (an antibiotic), Lyrica (an anti-epileptic drug), Relpax (an anti-migraine drug), Celebrex (an anti-inflammatory drug), and Depo-provera (a form of birth control).

Add in to the mix previous settlements for the illegal marketing of the epilepsy drug Neurontin ($430 in criminal and civil penalties), another settlement for more illegal Lipitor sales ($49 million in civil fines), and illegal marketing of human growth hormone Genotropin ($34.7 million), and the words "continuing criminal conspiracy" spring to mind.

And now a Pfizer salesman wants to lecture me on veterinary drug sales?

Oh joy and mirth!


Your Daily Dose -- now fortified with irony.


Since a salesman for Pfizer Animal Health was stupid enough to shoot me a "nasty gram" email to my home, I figure I might as well go ahead and use his résumé and his company's already soiled name to illuminate how pharmaceutical sales work in general, and how veterinary pharma sales work in particular.

I've got to write about something after all, and it's been a while since I beat this particular drum.

To begin, let's look at Mark Tye's experience.

He is a graduate of Oklahoma Baptist University with a degree in Spanish.

No science background at all.

In fact this is normal in pharmaceutical sales, and for a reason.

As filmmaker and former pharma sales rep Kathleen Slattery-Moschkau explains:

When I first came to work for [pharma companies] I was 23 and a year out of college. I majored in political science. That was my “science background.”

I really avoided science like the plague as an undergrad; it was just not my strength. I went to work for the cellular phone industry right out of college selling phones for about a year. Then one day I got a call from a recruiter who had asked me if I had ever considered pharmaceutical sales. I said “No, I don’t have a science background.” He basically said that they can teach you all that you need to know. They’re just looking for someone with sales experience....

When I look back, I think [the lack of any science background] is part of the reason that they recruit people like me – political science majors, history majors, business majors – because I didn’t have the ability to question anything they told me.

I can’t tell you how quickly I could get in over my head if I was talking with a physician about these things. Although I might have known a specific amount about my specific pill or a specific disease stage, once the doctor started asking questions outside of that, I would start to glaze over.

The typical course of my day would be going out, driving around to different physician’s offices, making appointments, and schlepping in a lot of food.

We used to joke that you don’t even need a political science degree for this job; you need a professional caterer’s license.


Mark Tye fits this mold perfectly.

While he claims vast experience and deep knowledge it's mostly bluff, bluster and bunk.

His real background is just 6 years and four months in veterinary sales, and for a single company.

Mark Tye's first job out of college was as a regional sales manager for a consumer finance company (June 1986-April 1991). His next job was as a sales manager for a consumer electronics concern (April 1991-December 1999), and after that he worked as a recruiter for an information technology company (December 1999 to December 2001). He then worked in sales for his family's document copying company (December 2001 to February 2004), before being hired on at Pfizer.

Nothing wrong with any of this, but let's be clear; Mr. Tye's expertise is in separating people from their wallets. It's not dogs, it's not cats, and it's certainly not health care policy, law, ethics or economics!

So that's Mr. Tye, and the company he works for.

Now what about his division, and the products they sell?

Pfizer Animal Health has a lot of products, and I don't have the time or energy to go through them all of them, but I'm going to look at a few products targetted to dogs so you can get a general idea of how it goes.

One of Pfizer's main sales products is Rimadyl. As I have noted in a previous post, Rimdayl is a COX-2 drug, and most of the COX-2 drugs like Bextra (see previous mention of Pfizer's record criminal and civil fines) and Vioxx were pulled from the market after they proved to be harmful (Vioxx, to put a point on it, may have killed over 25,000 people in just four years according to the FDA).

Pfizer Animal Health's COX-3 drug, Rimadyl, (aka Carprofen) is not approved for human use because it has so many serious side effects it could not compete against the other COX-2 drugs in the human market, and this was even before those other COX-2 drugs were withdrawn from the market.

But don't take my word for it. The Wall Street Journal reported on March 13, 2000 that "Most Arthritic Dogs Do Very Well On This Pill, Except the Ones That Die".

Except the ones that die?

Woops! I'll bet that's an article that never made it into Mark Tye's veterinary sales kit!

For the record, my objection to Rimadyl is not that it might kill your dog (a very low chance), but that it is unnecessarily expensive due to Pfizer and veterinay practice price-gouging, and because it requires an expensive visit to the vet for a prescription.

For the record, COX-2 drugs have never been proven to be better than common COX-1 drugs (i.e. NSAIDs) such as Aspirin and Ibuprofen. They are simply more expensive and less safe for dogs (cats are a different issue), and NO, they are not gentler on the stomach than buffered aspirin.

Knowing that, why would anyone dose a dog on Rimadyl?

Of course there is an answer, but it's not an answer that Mark Tye or any veterinarian wants you to hear.

That said, if you know where to go, you can hear it being said and see it too.

At a Pfizer-specific online bulletin board for veterinary sales representatives, for example, someone wrote in to note that "A family member of mine paid $58 for 6 pills and they were Rimadyl and I work for [Pfizer Animal Health], so I know that these mark-ups can go this high."

Right. Point made, and by a Pfizer Animal Health employee to boot! Nice.

Another drug being sold by Pfizer is "Slentrol." This is the drug you are supposed to give your pet if it is obese.

What??! We are supposed to be drugging our dogs because they are obese??

Anyone else see a problem here? Gina Spadafori over at Pet Connection did.

She notes that obesity in pets is a human problem, not a pet one, and that the cure is not drugs for the dog, but self-restraint on the part of the owner.

Want to save yourself $2 a day? Take a walk with your dog (it’s good for you both), or play with your cat. Cut back on the treats. Use the tried-and-true trick of substituting shredded green beans for some of the volume in your pet’s dish, and steel yourself against begging.


Excellent advice!

But, of course, it's not the kind of advice you are going to get from a Pfizer Animal Health sales representative struggling to make his or her quota, is it?

Another drug marketed by Pfizer is Convenia. As I noted in a previous post:

[This] drug is a one-time injection which provides up to 14 days of antibiotic treatment for common skin infections.

The injection must be administered by a veterinarian, which will cost you about $80 for the visit.

What neither a vet nor Pfizer will tell you is that you can get cephalexin to treat skin infections at a fraction of the cost and without a visit to the vet or a prescription.

Shhhh! Tell no one!.


OK, so Pfizer's sales force has its full share of fools, the company has embraced a culture of corruption, and at least some of the products are crap.

But what about the veterinarians? Surely they are all models of cost containment, self-restraint and probity?

Well some are, but certainly not all of them!

As I have noted in the past, vetererinary ethics are about the same as you will find in any poorly regulated trade with few consumer protections, and a public that is not too sure of what it is that they are actually buying.

Are all vets price-gougers, bill padders, and flim-flammers?

No, of course not!

That said, all vets are human, and they are not any more (or less) honest than car mechanics, human doctors, or anyone else.

Caveat emptor with all vendors, and especially when you are being "handled" by a "vet tech" or receptionist whose job description is to set you up for "additional services."

To be clear: these front-office people know next to nothing, and generally have been hired to give the real veterinarian cover in case the client calls "bullshit" to the veterinary equivalent of "Can I Super-Size your meal?"

A word to the wise should be sufficient: use Google to get informed and cut costs, do as much basic veterinary stuff as you can yourself, and negotiate pricing with the veterinarian, not the receptionist.

Finally, never forget the best money-saving advice ever, in terms of canine care: Breed choice matters a hell of a lot.

For more on that, read Making and Breaking Dogs In the Show Ring and peruse the canine health links in the blog roll at the right.


Once again, you do not have to take my word for anything.

A reader of this blog is a veterinarian, who left the retail vet trade to work in the regulatory arena. As Sara B notes in A Vet Writes About the Veterinary Business Model:

About five years ago, I was a young enthusiastic new grad and I was looking forward to serving my patients and clients. Instead I was constantly reprimanded for not adhering to 'protocol'. I was chastised in front of the staff for scripting out medications to local human pharmacies where I knew my clients would get a financial break for drugs that were exactly the same as those on our shelves. I didn't always want to use the laser for surgeries. I told people to purchase bottles of goat Panacur at the local farm & barn store instead of selling them pricey Drontal Plus tablets. I didn't recommend the Lyme vaccine. I didn't vaccinate everyone every year for distemper. I will surely burn in hell for mentioning the use of ivermectin rather than selling boxes of HWP to my beagle & coonhound kennel clients. I constantly spent too much time talking with the clients in each appointment. I would "give away" recheck exams. I didn't really care what brand of food people fed their pets (Most of the time they were being fed too much anyway!) And, most egregiously, I was forever giving away nail trims.


Now to be clear, good honest vets DO exist, and you CAN find them if you look.

But as I noted in the very blog post that seems to have gotten Mark Tye's underwear in a knot, the best thing any of us can do to contain costs and push back on chiseling corruption is to begin doing a few things ourselves.

Above all, we can stop going to the vet for “well pet” visits and unneeded shots.

We can end the yearly teeth cleaning nonsense, and take control of end-of-life decisions.

We can give our pets their own vaccines.

We can worm our own dogs, and we can stop giving heartworm medicines all winter long.

We can treat our own dogs for Lyme disease, and stop the testing altogether.

We can stop buying "diet” dog foods from the vet and start feeding less.

We can learn more about cruciate ligament injuries and be a little less quick to operate at a cost of $3,000 per leg.

And, of course, the most important thing we can do is find an honest non-price gouging veterinarian.

They exist within 15 miles of all of us if we will only take the time to research and look.


THIS is heretical information?!

Apparently it is if you are a salesman working for Pfizer Animal Health!

Caveat emptor!


Get your own Pfraud t-shirt here!

Just Like Grandma Used to Make




Cherry tomatoes Just Like Grandma
Used to Make at home. Just as
good as fresh.
Acrylic on 10x12 panel board.

No Longer Available

Friday, May 28, 2010

And Then There Were Three

Don't you love the scent of fresh roses. Bold and
beautiful. Standing alone, but not for long. My daughter
sent me a bouquet for mothers day. Still they look fresh.
This painting is for sale. 5x7 acrylic on panel board.

Day +9

Yesterday I had an all-star cast of caregivers which is exactly what I needed. I had the same nurse for 12 hours and her energy never faded throughout the shift. She was efficient, friendly, and genuinely happy. She was always smiling and humming anytime she was in the room. It was exactly what I needed as I was very tired and lethargic as it's been many, many days since a good night's sleep (as I write at 4 a.m. ...), but her energy was contagious. It's all about attitude. Another nurse who I had my first day was back to help out with my transfusion and I love talking to her because she has been working with stem cell transplant patients forever and is incredibly knowledgeable about it all. She helped me more fully understand what is happening in my body at this point in the process. One of my favorite PCAs was back that always calls me Miss Diamond. And, even the woman that transported me to a CT Scan was so talkative and friendly.

It was a busy morning. I received another transfusion of platelets and a repletion of magnesium. They also drew yet another set of blood cultures because of a fever the night before. Again it took three nurses to pull from my arm vein. Now it's just comical. I just look away and focus deeply on my breathing.

Unfortunately I still had a few fevers. I'm hovering around 100 and got up to 101.3 at about 5pm. All the blood cultures keep coming back negative for any viral or bacterial infection, which is good. Dr. Cooper ordered a CT Scan yesterday to take a closer look at my chest and upper abdomen to see if there is anything going on there as I've had persistent dry coughing spasms especially at night and in the morning, but that's been happening for weeks. Preliminary results showed nothing that would be causing a fever and revealed that my lungs look nice and clear – also very assuring.

My white blood cells are just about fully recovered now so they are thinking that if I did have an infection, my body would be strong enough to fight it. Therefore they have stopped the IV antibiotics and I am just continuing on the oral ones –some of which I will for six months as part of the protocol.

Rather than an infection, what we are now looking at as the fever cause is an inflammatory response happening in my body due to all the action in my bone marrow and all of these young, vibrant cells taking over the tired, weak chemo-compromised ones. Sometimes as the cells graft together the body can mistake the new ones as invaders and react causing a fever. This is not uncommon in transplant patients.

As of yesterday evening's talk with Dr. Cooper, after the next fever we're going to try a course of steroids (prednisone) to calm my body down and reduce the flare-ups. If the fevers go away after that then the mystery is solved and I'm free to go home. I believe the steroids are a few day course so I don't expect to be going anywhere anytime soon ... .

With my contact precautions now lifted Craig and I were able to spend some time in the healing garden yesterday which was nice – and we can now hug instead of fist pump which is double nice. We spent the afternoon watching funny movies and doing a little napping.

Unfortunately I'm still hooked up to the IV pole for regular saline maintenance fluids. It's certainly getting old being tethered for nearly a week now and I'm going to ask the resident this morning if we can discontinue that too since I'm having no problem eating and drinking. If it means I have to drink 18 pitchers of water a day I'll do it if it means I don't have to lug this thing around with me. My taste is certainly not fully recovered, but it's much improved and therefore so is my appetite. I'm told it could take weeks for my tongue to react normally again to flavors.

It's really not so bad here though. The room is so spacious, I have my own bathroom, shower, and fridge, and I have a couch and a recliner so I don't have to be in bed all of the time. What I love most is the view I lucked out with. I can see all the way to Sleeping Giant mountain with so many lush, green trees and a beautiful red rock formation to marvel at. Last night I could see the bright lights of a night game in a baseball stadium and that made me smile. The night before I witnessed an awesome lightning display – full sky to mountain strikes. I've never seen a thunderstorm so vivid. My view is to the west so I've caught breathtaking sunsets every single night.

I'm happy to have a new plan of action and hoping that these steroids do the trick and I can bust out and take a long, deep sleep in my own bed – after a good tennis ball fetch session with Sammy of course.


Thursday, May 27, 2010

Be Your Own Advocate

After six days as an inpatient and a total of over a month spent in the hospital this spring alone, I can't express how much I appreciate a good nurse – and maybe even more so – a good PCA. But even with the best care, it's so important for anyone who has to go through this to know how vital it is to be your own advocate and to have a full understanding of the care that you are supposed to receiving, the drugs you are supposed to be getting, when you are supposed to be getting them, and keeping track of your symptoms. You must pay attention.

I consider myself to be a pretty intelligent person and the journalist in me prompts lots of question asking and fact gathering. Every single day I've been here my heart aches for cancer patients for which English is their second language or who just can't wrap their head around all the medical terms or who just zone out and leave it to the nurses and doctors to handle. I can empathize with why other patients may be like that ... they don't want to know what's going on, they just want to close their eyes and get through it because it can be really, really overwhelming, but that does not work for my personality. And I'd venture to say that that's the case for most other young adults in my situation. I have caught so many near mistakes and told so many nurses how to do things that it's quite scary.

To be fair, I realize that no one knows my individual medical case nor my body better than I do and I've been watching people treat it and care for it for more than a year now. But I did not go to nursing school and I don't deal with patients all day every day. I do not comprehend how those that do still cannot draw blood, work on a cancer floor and can't change my port dressing or don't know tricks to get blood from my port if it is being finicky. I just spent 20 minutes with the nurse who couldn't get more than a little blood. She had no idea how to problem solve. I told her that when it happened in the clinic once they had me breathe, cough, lie very far back, put my arm up and I walked her through each of those things to try.

This is the longest stretch that I've ever been in the hospital and unlike just getting chemo which requires action for only about five hours of the day, I require a lot more work and obviously the lazy nurses do not like that. I had contact precautions instituted meaning that anyone that comes in needs to put on a gown, gloves and a mask first. The number of people checking on me reduced dramatically. I never even met my evening PCA and my night one has checked my vital signs once despite the fact that they are supposed to be monitoring my incessant fevers so closely. When I ask the nurse again if he would be coming around to check I hear that he is "rounding" ... well I am "burning up."

The dinner delivery person apparently didn't want to deal with putting those precautions on either. After 90 minutes passed from the time of my order and my food still had not come I called up front and the nurse dispatcher person said she would check if it was in the communal kitchen area. Didn't hear back for another half hour. Called again. She said she was sending my PCA to go look. Finally he comes in with the tray which was salmon and rice and says he found it in the nourishment room. I had been delivered at 6pm and therefore had been sitting there at room temperature for two hours. He told me that he microwaved it for me so hopefully it's hot enough. Are you fucking kidding me, I thought? I'm neutropenic, on a low-bacteria diet and I'm going to eat a tray of food that has been sitting out for two hours? And you can't tell me that no one ever walked by that tray. The "not my patient" or "not my job" attitude is ridiculous. So I ended up with pasta on a styrofoam plate at 9pm.

Some nurses will leave wrappers and caps from syringes and bloodied alcohol wipes on the bed and I'll find them in the sheets. The other day I had to wait hours for someone to come and change my bedding. I was so tired and wanted to take a nap but my sheet was covered in blood from the massacre that went down when – God forbid – they had to take blood from my arm.

I had to force one nurse to go look back at the orders when she did not believe me that it is protocol to give Tylenol and Benadryl before a blood transfusion. After she checked the computer she came back in with a Bendaryl pill for me and didn't say a word. I've broken out in hives from platelets every time even with Benadryl beforehand and had to get more during ... can you imagine what would happen if I didn't speak up?

And the absolute worst is the "shift change void." If you need something between 6:30 and 8 a.m., 2:30-4pm, or THE worst, 6:30-8pm, you're screwed. The worst was Tuesday night when at about 6:30 violent, shaking chills came on. Again, my sheets had not been changed and were sweat-soaked from breaking fevers the night before so I was sitting up on the couch wrapped in a blanket uncontrollably shaking, my teeth chattering. I knew a fever was coming on and I knew that Tylenol would stop the chills. This is what has been happening every four hours.

I called for the nurse, told the dispatcher person what was happening and she said, I quote: "Well, it's shift change ... I'll see what I can do." Half hour goes by, no one comes. The chills are more overtaking. I call again, say that I am spiking a fever, that I need Tylenol. Again, "It's changing of the guards" and some babble and as I continue to protest she just hangs up. Craig goes out in the hall to find someone, anyone. The nurse he talks to says "oh, I thought I took her vitals before ... ", mumbles something else, her phone rings, she takes the call and literally just walks away from him. Ninety minutes later my night nurse comes in and at this point I am in tears explaining to her what happened. She said she came in as soon as she arrived, which I knew was true as she is a fantastic nurse who I was lucky to have for several nights. My temperature had risen all the way to 103. She already had Tylenol in hand and gave it to me immediately. Apparently when the afternoon nurses are done, you are dead to them.

To counteract the frustrating caregivers, I have also had some phenomenal, phenomenal nurses and PCAs that have gone far above and beyond. They've been efficient, proactive, anticipate my needs and are right on top of things. You can tell that they generally care and that they are in this profession to help people.

And when you get a good nurse and PCA at the same time that work as a team, it's heaven. The past three nights my duo has been amazing. They would coordinate so that when the nurse came in to draw labs or to change over meds the PCA would come at the same time and do my vitals so that I wouldn't be woken up twice. They brought fresh ice water without me having to ask and checked if my hat was full every single time. I tell you there is nothing worse than overflowing your own pungent antibiotic laden urine over and over until they decide to come empty the hat that I have to pee in every time.

It makes all the difference in the world when you are treated with respect and kindness, when the nurse walks you through the care plan for their shift, when they tell you what is happening with your bloodwork, what you can expect to happen next, when they check in just to see if you might need anything, and when they spend the time to talk to you, show compassion, get to know you. Compassion is the big thing and you know if they have it or not within the first 15 minutes. Some are just going through the motions but some make it their mission every shift to be sure that you are as comfortable and as cared for as possible because they understand what you are going through is pretty close to hell. A smile, laugh and a gentle touch on the arm go a long, long, long way.

I have also been more than impressed with the oncologists, hematologists, residents, fellows and interns working on my case. They are all at once extremely intelligent and extremely caring and do such a good job at making something as abstract as a stem cell transplant understandable.

I suppose that there are individuals who are outstanding, so-so, and terrible at their jobs in every profession, but in this one it's lives, not printer cartridges that are at stake. Even in my most frustrated moments I maintain my devotion to the "kill 'em with kindness" method. There are ways to stand up for yourself without snipping and bitching at people. And the reality is that like them or not, that is the person that is going to be caring for you often times for the next 12 hours and when you need something you don't want to be the patient they ignore. Plus, they're the one wielding the needle.

When I'm appalled at a transporter pushing me on a stretcher to x-ray and groaning about how long of a day it's been for him or a nurse telling me how eager she is to get out in two hours I constantly go back to the Plato quote: "Be kind, for everyone you meet is fighting a hard battle," but sometimes it's hard to swallow people's insensitiveness. I'm pretty sure that at this moment in my life my battle is probably at least on par with whatever one they are fighting that's making them drag their feet and moan in gloom.

Johnnie Red

Johnnie Red is a boastful red bird just sitting alone in the trees
standing his ground. He will not give in to others. No way! he
rules his roost.
Acrylic on 5x7 panel board.
This painting is for sale.

My Justice Would Be Swift and Done With a Sword



A reader of this blog writes:

I read your blog every day and while I haven't as yet commented on any posts I am always interested in what you have to say. My daughter is a sophomore at The Ohio State University and is majoring in animal science. This is an email she sent me. I hope that you will read this and investigate this story. If what Mercy for Animals did to this dairy farm family is true, I am outraged! I told my daughter that this dairy farm could not stay in business for 80 years if they treated their animals the way you see them treated on this horrible video. I do not for a minute believe it and yet so many people will look at the video and they WILL believe it. Please help. Thank you for your time.

Feeling a little uneasy, I scrolled down to find an email allegedly written by Mariette C. Benage, Coordinator, Student Success, Department of Animal Sciences at Ohio State University. The email reads:

Dear Students,

Here is a story that I just learned about after class today. I'm passing it along to you as an example of both direct pressure and animal activist techniques that you, as young adults, need to be aware of. My personal opinions about this are unprintable!

All:

Ryan Conklin, a senior in our department, has asked me to put out this email to you to make you aware of a situation involving his family farm in Plain City. At 11:00 today there will be a news conference that will show terribly graphic footage their animals being mis-treated on their dairy farm. Ryan told me that a man was hired to work on their dairy last month that turned out to be an under-cover investigator for a group called Mercy For Animals, an affiliate-I believe-of HSUS. Ryan told me that this man from Mercy For Animals coordinated the video footage with another person working at the dairy, and he is the one seen causing the abuse on the video. The person recording the footage is the Mercy For Animals advocate, and he quit his position at the dairy on Sunday. The young man seen in the video was released of his duties at 6 am this morning.

I know some of you in the department know Ryan and his family very well, and I can tell you that they are very honorable people and that they would NEVER condone any of these actions. I believe they’ve been in the dairy business for close to 80 years, and they are certainly people that genuinely care about the well-being of their animals. This appears to be a trap that HSUS has set up to gain voter support in the state at the expense of a well-known dairy. This is a very difficult time for the family, and I know Ryan would appreciate any support that we can offer.

For those of you that are interested, here is the link to the video: http://www.mercyforanimals.org/ohdairy/

I will warn you…it’s not easy to see.

Now I was beginning to really feel uneasy.

You see, here was an employee of Ohio State University writing to students about an explosive and legally actionable issue, and suggesting to them that there was a smear campaign being waged against an "honorable" family farm that had never abused animals.

And yet this Ohio State University employee had quite obviously not taken a minute's time to actually investigate the situation!

"Who are you going to believe, me who has not bothered to investigage anything at all, or your lying eyes," she seems to be asking.

Wow! The stupidity of this email was dizzying.

Bracing myself, I went to the video tape.

When it comes to abuse, I thought I had seen it all. Apparently not.



I wrote back to the regular reader of this blog, trying to measure my words as carefully as possible.

How could anyone see this video tape and frame the story as if the dairy operator was the victim? My mind boggled:

Sorry, but this one does not pass the smell test and I will be going in the opposite direction.

I cannot speak to what the farm management knew or did not know (a court will decide that), but a couple of points need to be made here:

  1. No one is going to voluntarily appear in a video showing this kind of abuse. The suggestion that this was a put-up-job is complete nonsense. What is shown in the video is extreme, shocking and totally unnecessary violence to animals, the kind that gets you a prison sentence in a place where your teeth are pounded out with a bar, and your assh*l* is stretched by your bunk mate. No one signs up for that tour. No one. Ever.

  2. This is not just one person doing violence, and this video tape was not shot in one day. This video tape shows at least two people doing criminal violence to animals, and the change in clothing makes clear it was shot over at least six or seven days.

  3. If farm management did not know what was going on here, they are criminally negligent. The employees shown here are overt sadists and sick twisted souls, and this fact would have been self-evident over even a brief period of time. The fact that this farm hired these people and retained them, speaks to negligent omission at best, and criminal comission at worst. They better get a damn good defense lawyer and throw the people on the video tape under the bus!

I do not feel sorry for this farm<; I feel sorry for these cows and the honest and hard-working dairy industry of Ohio which has been tarred by this horror. You want me to defend this farm and suggest Mercy for Animals or HSUS (allegedly, by inference and suggestion) put up some kind of fabrication? Nope. Sorry, but I am not blind or stupid. Very clearly, the managers, owners and administrators of this dairy, however, are. It is a horror. It is a sadness. And YES, someone needs to go to jail.

Put me on the jury and I assure you they will.

Any question of where I stand?

Just because I stand for farmers, do not salute every inanity of the animal rights community, and will not wink at the direct mail pettifoggery of the Humane Society of the U.S., does NOT mean I will ever defend true animal abuse.

Put me on the jury, and make me jury foreman, and I will see to it that the men in this video get the electric chair if that is at all possible.

Sadly, however, it is not.

You see, one of the people on this video tape has already been arrested.

But guess what?

The people beating and stabbing these poor cows and calfs are only going to be charged with a second-degree misdemeanor punishable by up to 90 days in jail and a fine of up to $750.

Outrageous!

If an animal abuse case ever cried out for criminal prosecution with real jail time, this is it.

But in Ohio, farm animals apparently have no real protection even from this kind of wanton and horrific cruelty.

Should that change? Very clearly, YES.

.

Wednesday, May 26, 2010

Day +1 to Day +8 Recovery

It's been quite a ride. And I thought that I've already been on all the scary rides at the amusement park over this past year. Lots of ups and downs. Lots of gut checks. Lots of spins, confusion, weakness, chills, sweats, even some diarrhea and puking. It's actually been quite like continuous long days at Six Flags after too many spicy fries and soft serve cones combined with centrifugal rides that make you stick to the wall while the floor drops out from under you.

Last Thursday we moved down to New Haven into the hotel suite. It's pretty tight quarters but has a kitchen with all the amenities, a living area, and a super comfortable queen size bed. The night before I was literally on hands and knees trying to pack a suitcase with 15 days worth of things that I would need but so far somehow I didn't seem to miss anything. My mom had bought me a huge pill box with openings for morning, evening and bedtime for each day and counted out all the antibiotics and anti-nausea pills that I would need to be taking. The antibiotics are like horse pills and were especially a bear to get down due to my incredibly uncomfortable mouth. By Thursday I had no taste buds and my entire tongue and mouth was coated in a white film and it felt like I had a tube sock stuck in there. Never mind the nausea and gag reflexes kicking in when trying to take them, but I'd gotten them all down, knowing that if I couldn't get them down that I would have to be admitted as an inpatient and I was trying to avoid that at all costs.


Thursday's trip into the clinic went fine. Then it was the same drill on Friday. I got my blood work done then received a Neupogen shot to start boosting my white blood cells and two bags of fluids to keep me hydrated and keep my blood pressure up. On Friday we were there for several hours but it was beautiful out and Craig and I played cards out in the meditation garden until my IV pump ran out of battery and we had to head back in. Afterward I was feeling pretty strong. We went on a drive through New Haven, rented some movies for the week, and went to the beach where we laid out on a blanket and read in the evening sun. Back at the hotel my appetite was feeling better than it had in days so I had some Annie's mac and cheese with spinach and chicken sausage. We curled up to watch a movie and I was feeling "good" (a relative term, of course).

Then the clock struck midnight and all hell broke lose. I could literally feel my upper and lower intestines throbbing in pain and it was bathroom trip after bathroom trip doubled over with horrible diarrhea. They told me the Melaphan chemo drug would cause this but I never imagined it to be that bad. I was up all night transferring from fetal position on the bed to hunched on the toilet. By 8am when we had to head to the clinic I was incredibly weak, still in a lot of pain, and unaware if things were going to act up again. Every movement was so cautious, Craig comparing me to a 97-year-old woman and that's really what I felt like.

We rolled in and they tried to put me in one of the chemo pods but I told them that I needed a room with my own bathroom and explained the night. I was sent t0 the far end of the hall. Being a Saturday it was bare bones staff and Craig and I sat in there for nearly 45 minutes before anyone came to get me started, check on me or put a pillowcase on the pillow. Finally our call bell was answered and we came to realize that this would just be the day of hellish care. Note to self: try not to feel awful on the weekend shifts. When the nurse finally came I told her that I was having wicked back and stomach pain and about the night 'o diarrhea. Because of that she called the on-call fellow - also not much help. Then luckily Dr. Cooper swept in.

At this point I was downright weapy, all teary-eyed and choked up because I just felt so, so shitty. I told him that I'm usually really tough and I was just feeling awful. I couldn't help the hot tears from streaming down my face and had to keep wiping them away with a tissue. I was running a temp of 100.1 and because it was still so early in the morning he said it was safe to assume that it would only rise throughout the day and made the decision to admit me and get me on IV antibiotics. Though I certainly did not want to be back in the hospital again, I knew it was the best, and the safest thing to bring out the heavy antibiotic guns and to be monitored at all times.

So the preparation for admission ensued. While in the clinic they took blood cultures to test for any bacterial infections. Most could be pulled from my port but some have to come from a peripheral vein in my arm in case the infection was in my port itself. This took two nurses on their knees, three vein pokes and an arm that was about to explode they tied the tunicate so tight and had to leave it on so long because my vein was only dribbling. I was just so tired that it was all I could do to breathe deeply as my eyes continued to well.

I was then admitted to the solid tumors floor as that was the first bed to open up. There I received two units of red blood cells and four units of platelets. My nurse was nothing short of a nightmare. I've had wonderful, wonderful nurses, mediocre and some doozies but never one like this. I was so out of it, but luckily coherent and smart enough to know to advocate for myself. It was one thing after another after another that just wasn't going right with her. Dr. Cooper came up to see me and when I got all teary and told him that she wouldn't hook me up to fluids flippantly saying that I didn't need them and that I had to convince her to recheck the orders to see that in fact I do need Benadryl before platelets. Hearing all of this he stood up chest puffed out like an ape and he ripped his paper gown off like Clark Kent revealing his Superman undersuit and went into the hall to find her. I'm pretty sure he reamed her a new one because when she came back later she asked me: "What was that doctor's name?" The next morning he made sure that I was transferred to the 11th floor which is devoted to blood cancers and I've been here ever since.

I really wish that I was up to writing over this past week but I just could not get the strength. And anytime I got close to it someone would come in to put me through something. It's not easy to keep a creative flow going here. But I guess it's also just a testament to how awful, awful I was feeling. Looking back on Sunday through today it's all a big blur. Maybe it's better to remember it that way. It's been a blur of all different antibiotics throughout the day and night by mouth and by drip, daily Neupogen shots that burn like hell, blood transfusions, magnesium and potassium transfusions. A blur of constant vitals checks, blood draws, chest x-rays, blood cultures, physical exams and the dreary eyed desire for an uninterrupted night's sleep. A physical blur of throat sore pain, vomiting, diarrhea, aches, and extreme weakness.

The worst of all has been the fevers which have continued since I was admitted on Saturday. Anywhere from 100.1 up to 103.2, never going below 99. Each would start with violent, shaking, teeth chattering chills. Despite wrapping myself in several blankets I could not warm up and could not stop shaking. They would give me Tylenol and all I could do was curl up in bed and ride out the chills until the fever broke and I was soaked in sweat. The hunt has been for the cause of the fevers to make sure I don't have any type of bacterial or viral infection. This is why they've been drawing so many blood cultures and I also have had to endure swabs up every orifice. So far, everything continues to come back negative.

I've never been bored. Not for a second. In fact I wish that I had more time to read or sleep or catch up on miscellaneous projects but again the energy or gusto was completely zapped. I've had either my parents or Craig here for a few hours each day with Craig coming for a couple hours after work each evening before he goes back to sleep at the hotel and commute the hour to work. We've watched movies together and my parents even brought bright garden streamers to decorate the room. But often it has been them watching me half-sleep.

All started to turn around on Tuesday and has been doing so turner for the brighter with each day. Until I come out of neutropenia and I stop having these fevers they will keep me here. What's helpful to keep in mind is that I am here to heal, not here to receive more toxic drugs. This means that when I do get released it'll be just to continue along the recovery path. This time once I start to feel close to myself again it won't mean that it's time for more chemo. It'll mean that I can keep the healing going.


Making Memories

Making Memories. Two little girls playing on the beach.
Both begging not to go home now. They savor every second.
Acrylic on 5x7 panel board. This painting is for sale.
UNAVAILABLE

Why Wood You Leave Me Like That

A lone Strawberry sitting atop a piece of wood. The second berry Gone?
But where? And why? How sad and delicious.
Acrylic on 5x7 panel board. This painting is for sale.



Ceramic Cuties

Ceramic Cuties , can't you just imagine a pair
of little antique birds cool and glossy sitting
atop an antique dresser and then a little twig someone
just happened to drop in front of them as if to tease the little birdies.
No Longer Available