Thursday, August 21, 2014

Who's Walking Whom (Who)?

The value of dogs as companions is well known to aid in life-long satisfaction, but not necessarily increasing the owner's longevity.  The article Pets and Longevity - Can having a pet help you live longer, the data suggests pets may not have been shown to have a direct effect on our longevity, people who rely on them for company, friendship and affection, will no doubt vouch for the impact animals have on their well-being- regardless of age.

This being stated, what do dogs bring to the relationship?
  • Loyalty
  • Friendship
  • Physical demands- exercise by default
  • No judgments
As the spouse of an animal "ENTHUSIAST", it is imperative to go with the flow and look at things positively.  The alternative leads to unnecessary conflict where you will always be the loser and "bad person".

We recently rescued a dog from a shelter that still has a euthanasia policy with 1 day left on death row.  The dog, though a handful, has added a new dynamic to the household routine.  Ricky "the dog", which came with a $10 fee has already learned our American Express card number!

Ricky is part Huskie and German Shepard and takes a walker on forced marches through the neighborhood.  The easy-walk type leash around the chest is significantly preferable for pulling dogs than a neck collars.  My upper body strength has improved since he arrived.

We have had dogs trained in the past, but trainers always train them in their vision of what a dog should behave like.  They do not train the dogs in the true reality of daily life in that household.  Absolute commandments like no sleeping in the bed and no treats are broken while the trainer is still in the driveway.  I suggest to train the dog to do the 2 or 3 things that are important to the owner.

Isolation and loneliness are common place as one ages, and pet ownership or human ownership depending on your world view will keep you younger and active.  There is a whole dog-walking culture out there ready for you to participate in.

Monday, August 4, 2014

How vital are Vital Signs?

Vital signs measures of various physiological statistics, often taken by health professional to assess the most basic body functions.  Vital signs are an essential part of a case presentation.  The act of taking vital signs normally entails recording body temperature, pulse rate or heart rate, blood pressure, and respiratory rate, but may also include other measurements.  Vital signs often vary by age.  Other signs are pulse ox or oxygenation levels, pain level, and BMI or body mass index.

Vital signs are used to determine the potential severity of illness and lead the provider to hopefully interpret the data properly to determine the most beneficial treatment plan.

Vital signs can tip the provider that patient is potentially ill when it is not clinically apparent yet.  Vital signs can also be used as an anchoring tool to deny how serious the potential illness is.

In addition, vital signs are a monitoring tool to watch if the patient is getting better or worse.  Sherlock Holmes and his modern day counterparts- the Infectious disease Consultant can reconstruct most complicated care by using the "slow" deterioration of the vital signs as critical time posts in the identification of the problem.

Vital signs need to be interpreted in the context of the situation.  They can be a clue to undiagnosed hypertension.  But a single value, the provider must follow up to see if they are consistently real.

Abnormal vital signs need to be rechecked or accounted for in the course of an evaluation.  A high percentage of malpractice cases are based on lack of documentation of the repeat vital signs prior to discharge.

As one famous ED physician once said, "Ignore the vitals and nurse's insights at your peril."  The astute clinician balances all the data in the complex rubric for medical decision making.