#i have a bias for short haired Marcy but like

[heart-wit-strength]

Pirate Marcy with long hair?? maybe??

[danithebookaholic-blog]

SPOTLIGHT!

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Designer Dogs, Awkward Hugs & a Pigeon Veterinary Tales, Again 

By Dr. P.J. Miller

Publisher: thirty8street Publication Date: September 1, 2018 Genre: Non-Fiction, Humor

Synopsis:

Dr. P. J. Miller is back! Following his first installment, Cute Poodles, Sweet Old Ladies & Hugs, Dr. Miller has compiled another volume of truly awesome veterinary tales. Come along for the ride again as Dr. Miller delivers stories that feature colorful clients, endearing pets, his own beloved bulldog, and a hurricane.

All the sassy hospital staff that readers came to love are back, including that special staff member who seems to work by her own particular standards of professionalism (you know the one).

In Designer Dogs, Awkward Hugs & Pigeons, Dr. Miller goes behind the scenes of his veterinary practice to provide a true insider’s view into life as an animal doctor. Dr. Miller employs the same unique style of humorous storytelling that readers loved in his first novel. Hidden behind the humor, Dr. Miller gives a deeper glimpse into how emotional and strong the human-animal bond can be. A must read for any aspiring veterinary professional or animal lover.

Goodreads

Excerpt:

That Tuesday 8:32 am (Two Years Ago)

I walked into the treatment area. Jen and Cassey were already getting samples for the annual exams. If I had been one of ‘those’ veterinary practice owners, I’d have been there earlier. Perhaps even lending a helping hand. I’m not one of those. Truth be told, this works out perfectly, at least for me. They check in

the owners and pets for their appointments and get assorted samples, and then I can start the appointments. It’s like my cue for a stage show, and my part starts in the exam room. Of course, Jen, our head technician, doesn’t see it that way.

“Nice of you to finally get here, Dr. Miller. I drive further than you do and I’m here. What’s your excuse this time? Traffic get you again? Don’t worry, we got all the hard work done for you already. It’s not like YOU got scratched holding that dog. Look at my arm...”

Once she started complaining, I instinctively blocked her out. I had heard it all before. When it comes to giving me a hard time, Jen never lets that opportunity pass her by. I decided to take the high road and refrain from passing judgment on her haircut. She had her black hair cut short to her shoulders, again. That, along with wearing her glasses instead of going with the usual contact lenses, made her a dead ringer for Marcy from the Snoopy cartoons. Jen always hates it when I call her that but I had used that one before and it was getting close to being played out.

So, instead, I headed straight to the fruit arrangement that we’d got yesterday from the Goldbergs. It had just been taken out of the fridge. It was sitting on a counter in the treatment area, seemingly for my enjoyment. I usually wait until after a couple of appointments to start snacking, but after Jen’s complaining, I figured I deserved an early chocolate strawberry.

I grabbed the patient record sitting in the exam-room door and Cassey led the way with Elwood. Elwood was a hyper five-year-old boxer. Cassey was struggling to hold the end of his leash. Her short, thin stature was no match for him. Her blonde ponytail jumped in rhythmic coordination with each one of Elwood’s jerks on the leash. It didn’t help matters that he was overly anxious to get back into the exam room with his owner, Mr. Trudeau. Mr. Trudeau was about fifty-something. The remainder of his blonde hair was slicked back, and his skin could not be any darker. He was one of our more unique clients. Even though we only saw him once a year, he was definitely one of those clients who stood out. If our practice ever enforced a dress code policy, Mr. Trudeau most likely wouldn’t make it in.

He was wearing a bright neon green safety vest, black sweatpants, and work boots. His fashion faux pas on this visit was the thin plastic safety vest that represented the only garment on his torso. His hairy blond chest was exposed and accented by a gold chain that held a small medallion of some sort. Mr. Trudeau is always nice to us but he is always short and to the point. Because of his self-appointed dress code standards, large frame, and matter of fact tone, he gives the impression that he is a person that you don’t want to upset. Further complicating things, you really never know if he is joking. This makes almost any situation awkward. Luckily, Elwood remains healthy or is never seriously ill enough that Mr. Trudeau thinks we need to see him. We only see Elwood for his annual exams.

“Hey, Doc, how’s it going? Looks like Elwood is ready to get out of here. He thinks he’s all done,” he said letting out a laugh. Mr. Trudeau was sitting on the exam-room bench with his back straight, his legs slightly apart, and his left hand on his knee supporting his upper body. Had he been wearing a suit and tie instead of his normal attire, his perfect posture and intense facial expression would make him look like he was a businessman ready to close that big deal. That image, of course, fell apart, as the neon safety vest left little to the imagination, putting his tanned hairy chest and pot belly on full display. Cassey knelt down next to Elwood, holding him, as I started my physical exam.

“Elwood looks like he’s doing well. Any changes with Elwood you want to talk to me about? Any lumps or bumps you may have noticed?” I asked as I finished up my exam.

“No, Doc. What you see is what you get. He’s doing great. He did sneak some BBQ last week... well, actually, I gave him a small piece. He had a soft...yellow, you know... number twos for a few days, but then it was back to normal. I know, I know, what you are going to say about table food. But Elwood is my buddy. Hard to resist that cute face. Right, Cassey?” He leaned forward in his seat and then hit her arm with the back of his hand. She let out a laugh in response. I didn’t know if she saw the humor in it or, like the rest of the staff, would laugh at any joke he made to avoid any potential conflict.

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“You’re playing with fire, man, especially with a boxer. They’re prone to upset stomach—”

Just then, Jen knocked and then leaned partially through the exam-room door. My staff never interrupt an appointment unless there is a real problem so, I already knew it was something serious. Even before I heard that name.

“Dr. Miller, sorry to interrupt but we have an emergency here.”

I excused myself and, as I left, I overheard Mr. Trudeau (not so) jokingly say to Cassey, “Looks like I dodged the bullet on that boring lecture.” I heard Cassey let out a polite laugh, as the door closed behind me.

“Dr. Miller, you ready for this one?” Jen asked sarcastically, holding the record in her hand. I could read the name on it. She already knew the answer to that question. I was not ready. No one would be ready for that record. In fact, anything associated with this particular name is bad news. Medical cases, phone messages, and even simple prescription refills, they’re all bad. If it bears the name Esposito and you’re involved, your day just got dumped on.

I’d be the first to tell you that Mrs. Esposito is a really nice person. If you met her or talked with her for any length of time you’d think she was a sweet lady. She’d probably remind you of a favorite aunt, or really cool grandma. You’d think my staff and I were all cruel and most likely burned out dealing with the general public. Don’t worry, she fooled all of us too when we first met her. We all figured it out eventually. Even Liz, who was the last hold-out to come around, tried to avoid anything with the Esposito name on it.

I’d first met Ann Marie Esposito five years previously when JJ was a puppy. She had just purchased him from a not-so-reputable source: “A friend of my sister ’s, who is a ‘specialty’ breeder.” She let us know he was the last one of a sold-out litter, and they let her buy him only as a favor to her sister. When Liz was checking her in, that first day, she told her he was a purebred Jack-A-Poo (a Jack Russell-poodle cross). Mrs. Esposito made certain that Liz’s spelling matched what was written on her little yellow notepad. If you were really good at reading people, better than we were, that little pad would have been the first clue.

Jack-A-Poo is not what we veterinary professionals consider a pure breed. By that, I mean, recognized by the American Kennel Club (AKC). As far as I am concerned, the AKC is THE authority on what is an official dog breed and what isn’t. In other words, if the breed can’t qualify to be shown at the big dog show in Madison Square Garden, it’s not an official breed. That doesn’t mean I’m some kind of dog snob and I only like purebreds. No, I am opposed to people selling ‘designer ’ breeds, especially for high prices. There’s no breed standard across the board on these breeds, and many of them are often quite different. From my standpoint, it would be better to adopt a dog that resembled the mix of breeds one had in mind.

As for Mrs. Esposito, she won us over (fooled us good) on that first visit. Like our other clients who fall in the designer-dog/fake-breed trap, we gave her a pass. She was engaging and open to all our recommendations. It was also obvious she had a strong love for JJ.

JJ was friendly and tried to lick us no matter what procedure we were doing. He never changed and was the model patient. He resembles almost every other Jack Russell-mix dog I’ve seen, and we have never been able to recognize any of the supposed special poodle components in him. He has a white wiry coat, with light brown spots, including a distinctive brown spot around his right eye.

I confess, I also got suckered in. I had an affinity for Mrs. Esposito because she was from New York City (Queens). And since I am from New York City, I have a bias toward New Yorkers. Most, unfortunately not all, New Yorkers turn out to be tremendous clients in my practice. The others that turn out to be not-so-tremendous, do so on their own. At which time, Jen will be sure to highlight the fact that another one of my favorite New York clients has either jumped ship or was kicked out. Eventually, Mrs. Esposito became another example of one of my prestigious New Yorker clients that Jen still likes to use against me.

Over the next few years, Mrs. Esposito’s visits became more frequent, and it wasn’t because JJ was actually sick. Since animals can’t tell us their issues, it becomes crucial to get accurate information from their owners. For the record, I don’t think my clients are all hypochondriacs. Actually, I usually go by the complete opposite assumption. Most clients are very astute about what is going on with their pet. I cannot tell you how many times I have diagnosed a problem because a client thought something wasn’t ‘right’ with their pet. The signs may not have been medically obvious at first but their instinct was correct. Unfortunately, Mrs. Esposito wasn’t one of those clients.

Believe it or not, Munchausen syndrome by proxy has been proven to occur in veterinary medicine. In that condition, a caregiver fabricates, exaggerates, or induces mental or physical health problems in those who are in their care. They do this, in order to get attention or sympathy. I don’t believe she had that particular syndrome but whatever she started doing wasn’t too healthy for our mental well-being. The majority of the time, when she called us with a concern or came in with JJ, it wasn’t a real medical problem. If it was a problem, she would blow it way out of proportion. Over the next few years, the concerns, comprehensive yellow-pad notes, and supposed illnesses seemed to multiply.

There were many of these instances but one of the most memorable was when she came in because she thought that JJ was having seizures. She had read up about epilepsy in dogs online and had already diagnosed him with it. Her yellow notepad was filled with questions about epilepsy and treatment options. This made getting information from her even more difficult because I couldn’t figure out if she was applying what she’d read online or describing the real signs that JJ was having.

As with several previous illnesses, JJ’s tests came back completely normal. I ruled out a lot of other potential causes of seizures with normal blood work. But on that occasion, I outed her with an even more modern and advantageous veterinary instrument; her cell phone. I asked her to record JJ’s episodes with a video on her phone. The next day when she returned to go over his blood work, she was excited that she had captured not one but three of these seizure-type episodes.

“Dr. Millah, I’m not crazy! And JJ does have epilepsy.”

I am only qualified to definitely respond to the last statement and I can tell that JJ is not an epileptic. It took me ten minutes to explain away the episodes. The first two—really one incident recorded over two clips—were of him rolling on the floor with excitement. The third was him happily rolling on his back in the grass sunning himself. I got her to promise she wouldn’t worry any longer about epilepsy or record any more videos.

It took forty-eight hours for her to break that promise and return with a video to show Liz, of him doing laps in her living room. Liz was able to talk her out of another appointment. For reasons unknown to me, Liz’s second opinion apparently was the confirmation she was looking for and she never recorded any more videos after that.

On that Tuesday morning, Mrs. Esposito ran into the practice and straight into an exam room. She was cradling JJ in her arms like a baby. Liz, thinking it might be a real emergency, left the front desk and ran in behind her. Mrs. Esposito immediately took a seat on the bench. She started rocking back and forth with JJ.

In her thick New York accent, she stammered, “We need Dr. Millah. JJ has been spittin’ up all night. This mornin’ he’s lifeless...lifeless!”

Liz saw that JJ was a bit lethargic but he was still wagging his tail even in her arms. She immediately knew it wasn’t the dire emergency that Mrs. Esposito made it out to be.

“It will just be a couple of minutes, Mrs. Esposito. I’ll get Dr. Miller.” Liz got his record and went to the treatment area to fill Jen in. As soon as Liz got done explaining things to Jen, Mrs. Esposito let out a muffled cry from behind the exam-room door.

“Liz, puh-lease, hurry! Don’t leave us hangin’.” After hearing that, Jen thought it would be a good time to get me out of the exam room with Mr. Trudeau and put an end to this situation sooner rather than later.

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I went into the exam room and Mrs. Esposito was wearing her classic attire. There are several clients in our practice who seem to wear a trademark outfit every time we see them, almost like a uniform. Mrs. Esposito was definitely one of those. She was wearing her patented white golf visor, velour tracksuit, and white sneakers. That day, the tracksuit was dark purple. She had (dyed) red, curly hair that reached her shoulders. She was a tiny woman, a few inches over five feet, and my best guess puts her in her late sixties.“Thank Gawd, Dr. Millah, are we glad to see you! JJ is not doin’ well. He must have spit up five times last night. I was up all night with him, wipin’ his little face. Then, this mornin’, he’s not eatin’ and he’s layin’ around. It’s like he can’t walk. I rushed right over. I knew you would want to see him.”

By the way, spit up is what many owners call vomiting. They think by downgrading it to spit up, it will make it less serious. Despite usually exaggerating everything else, Mrs. Esposito still calls vomiting spit up. I already knew getting an accurate medical history from Mrs. Esposito would be close to impossible. Not only does she embellish clinical signs but she will also throw in extraneous information.

“How many times has he vomited in the last twenty-four hours?”

“He’s not vomiting. It’s only spit up. After he spit up the first couple of times, I got worried. So, I started giving him Peedio-lyte with a syringe, so he wouldn’t get dehydrated. I have to go to the Walgreens by the park to get it ’cause the one near me stopped carrying the grape flavor. He seems to like grape the best. Dr. Millah, I can’t tell you how many times that Peedio-lyte has saved him when he got sick. When he spit it all up at six this morning is when I started to get really worried.”

I don’t advocate giving pets Pedialyte. I had also shared this opinion with Mrs. Esposito more than once. The last time, it looked like she had written my advice directly on her pad. I was convinced then that I had seen the end of the grape ‘Peedio-lyte.’

I never got an exact, or even close to accurate, number on the vomiting. The rest of the history (information about the sick pet) was also all over the place. I desperately tried to keep Mrs. Esposito on point but it was useless. After my last question, she started a whole conversation on an old-school remedy from her Italian grandmother.

The story was non-stop and I was only able to interrupt her in order to let her know we’d be taking blood from JJ. The story was so long that I did my exam, Jen left, got JJ’s blood, brought him back, and she still wasn’t finished. After Jen left for the second time, to run JJ’s blood work, Mrs. Esposito dropped a bomb on me out of nowhere.

“I’m surprised he is able to walk OK now. He could barely walk this morning. His hind legs were really wobbly, almost like he was draggin’ ’em all around da house.”

After she said that, I looked down at JJ, who Jen had placed on the floor. Usually, Mrs. Esposito would’ve scooped him back into her arms but she was so focused on our conversation she had let him wander the exam room. I watched him carefully and he was walking fine but did seem to have a slight limp on his right rear leg. In Mrs. Esposito’s defense, this happens all the time. Owners will bring something else up or ask me to check something else conveniently after the tech has left the exam room. Making matters worse, Cassey was nowhere to be found so I had to ask Jen.

“Dr. Miller, why don’t you do a complete physical exam the first time? It would save me a lot of time having to go back in for a second exam. This is going to be the last time, right? You better make sure she doesn’t invent any more signs after this ’cause I’m not going into that room again.” She finished her statement right before we opened the door to the exam room. Jen was already having doubts about whether there was actually anything seriously wrong with JJ.Despite her objections, Jen was a more than willing participant. I knew she was anxious to find out if anything was really wrong with JJ. Jen, like all of us, had an affinity for the little dog. But, for reasons I could never really figure out, she also had a bizarre affinity toward Mrs. Esposito. It wasn’t obvious to me at first. Later, though, I noticed it was always Jen who picked up the on-holds for Mrs. Esposito. She also spent ages on the phone with her, and without fail, seemed to linger in the exam room with her long after I was gone.

Jen placed JJ on the table. I thoroughly, at least this time, carried out his orthopedic exam. I manipulated both his hind legs and hips; he never showed any signs of pain or discomfort. I even manipulated his head and neck and palpated along his back and still nothing. Everything appeared normal. In fact, he started to become more animated after my exam. When Jen placed him on the floor he started racing around the exam room and even jumped up into Mrs. Esposito’s lap.

“I know you think I’m crazy but he couldn’t walk this morning. He acts like he’s fine now but something ain’t right. He’s sick. I know he is.”

“Aside from the problems with his back legs, and vomiting, anything else, at all.... anything that’s ...abnormal?” I asked trying to finalize his list of problems (real or otherwise), especially before Jen bailed out of the room. It wouldn’t have mattered anyway because before she could answer Jen was gone.

“No. Aside from not eating this morning, that’s it.”

“Well, let’s see what his blood work shows and then we can come up with a game plan,” I said as I excused myself and left the exam room.

Jen was just outside, in the lab area waiting for the lab machine’s printer to finalize his results. She noticed me inching closer, anxious to see if I’d get any info from his lab work, even though we both knew the answer.

“I don’t know what you’re expecting to find, Dr. Miller. You know it’s going to be normal. She probably slipped him table food and he’s got an upset stomach. You think she tells you everything she gives him? I’ll be the one who has to call and check on him tomorrow and she’ll confess it to me, you watch.” Just as she finished, she took the paper from the printer and handed it to me. Spoiling the surprise of his results she stated, “Normal. What did I tell you?”

She continued, “Treat it and street it! Let us know what you want for this dog. Cassey has got the next appointment to check it in,” Jen stated, motioning to Cassey who had just walked in from the door to the kennel area.

The ball was now officially in Dr. Miller ’s court. My biggest worry would be missing a potential diagnosis. Was Mrs. Esposito crying wolf again with JJ? I didn’t want to be negligent. I also didn’t want to go down the Mrs. Esposito hole and run a bunch of unnecessary tests, chasing down signs that didn’t even exist. I quickly dismissed any thoughts of a serious medical problem. I started thinking maybe Jen knew something I didn’t. Maybe her bizarre relationship with Mrs. Esposito had given her inside information that Mrs. Esposito occasionally slipped JJ table food. Table food is the most common cause of a simple upset stomach and pancreatitis. Both of which could explain the vomiting.

I went back in the room with JJ’s lab work. I slid it across the exam table to show it to Mrs. Esposito. I explained to her it was normal, and that we had enough blood to send to the outside lab to run a test for pancreatitis. The normal blood work had set her mind at ease that nothing was seriously wrong with JJ. Since JJ had walked around the room, and jumped up into her lap, even she was ready to overlook the slight limp as a serious medical problem. I went over the treatment plan (‘treat him and street him’ protocol). I told her we would give JJ subcutaneous fluids, an injection for the vomiting, and some narcotic tablets for pain. I explained to her it would cover his slight limp, and any abdominal pain if he had pancreatitis. I knew she would never admit, at least to me, that she gave JJ any table food but, at that point, I was convinced she had slipped him something.

I was wrong. My diagnosis wasn’t even in the same neighborhood as JJ’s real problem. But even if I had been medically paranoid, there was no test or medical plan I could have performed to diagnose or help JJ at that point. It turned out to be one of the most bizarre presentations of a relatively common problem I had ever seen in private practice. Mrs. Esposito would be back with JJ with a very real problem, and every ounce of worry would be justified.

Mrs. Esposito left, but not after talking to Jen in the exam room for over ten minutes. When Jen came out I confronted her. I reprimanded her for taking too long to discharge Mrs. Esposito. Reprimanding Jen at my hospital is exactly like when any stereotypical sassy, head nurse gets reprimanded on TV. It does no good. They usually have some funny comeback that only makes the doctor (patsy) look worse for opening their mouth in the first place.

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I have been working with Jen for over fifteen years and I’d learned this a long time ago. So, because of this, I chose my reprimands carefully. In this particular case, I was trying to get lucky that her comeback would involve a table food confession from Mrs. Esposito. I figured it would be worth it. It wasn’t.

“Dr. Miller, it’s not my fault that you can’t explain stuff clearly so that she can understand it. Some of these people need my touch, to lay it out nice and simple for them. I put their mind at ease. By now, you, of all people, should know that Mrs. Esposito is one of those people. Is it my fault that out of everyone in this hospital, she picks me to latch on to? Do you think I like that job? You’re welcome, by the way. I straightened it all out for you. She told me to thank you but you should be thanking me.”

I didn’t give Jen the ‘thank you’ she was looking for. Instead, I deflected and complained about having to check in the cat appointment with Cassey, which left me to do the tech work and to get all the samples myself. As expected, she failed to feel sorry for me replying, “It’s about time you pitch in and do some real work around here.”

Just then, we heard Mrs. Esposito scream out from the reception area. “He can’t walk. He’s paralyzed! Oh my Gawd, Liz!” The rest of the conversation was muffled. At first, I didn’t believe what I was hearing. There is no way there could be anything wrong with JJ. I had just seen him less than thirty minutes ago.

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Author Bio:

Dr. P.J. Miller was born and raised in the heart of New York City, Midtown Manhattan. He did his undergraduate course work at University of Florida. In his third year at UF he was accepted early into the prestigious Royal School of Veterinary Studies in Edinburgh Scotland. Dr. Miller graduated from Edinburgh in 1999. He has been practicing veterinary medicine in Central Florida for twenty years. Dr. Miller has been the owner of his own practice for over a decade. He lives with his wife and two children in Central Florida. He loves all animals, obviously, but is partial to bulldogs, chihuahuas, and cats that act like dogs. Like most transplanted New Yorkers, he's still looking for that perfect slice of pizza.

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