Mini Cheesecakes with Chocolate Ganache

So, I found this recipe on caligirl website that is no longer available and I can't find it anywhere else online. I wish I could share the credit, but I only saved a printed copy of the recipe I had in the kitchen. Hopefully anyone else looking will be able to find it here. I have made it more times than I can count and every time it is one I'm asked to make again.


Mini Cheesecakes with Chocolate Ganache

Crust for the bottom:

• 1 cup graham cracker crumbs
• 1 tbsp granulated sugar
• 4 tbsp unsalted butter, melted

Cheesecake:

• 2 (8 oz) packages cream cheese, room temperature
• 2/3 cup + 2 tbsp granulated sugar
• pinch of salt
• 2 large eggs, room temperature
• 1 tsp vanilla extract
• 1/4 cup sour cream

Chocolate ganache

• 2 oz dark chocolate chocolate chips
• 2 oz milk chocolate chips
• 1/4 cup heavy cream
• 1 tbsp unsalted butter
• tiny pinch of salt

Instructions
 Crust:

1.  In a Ziploc bag, crush crackers until they are crumbs. Add sugar and mix. Pour in melted butter and mix until all crumbs are thoroughly moist.
2.  Line a muffin pan with liners and drop a tablespoon of crumb mixture into each. Pat down until crumbs are flat and firm, forming a crust. Refrigerate.

Cheesecake:

1. Pre-heat oven to 300 degrees. In a large bowl, beat cream cheese until creamy. Add sugar, salt, vanilla and mix.
2. Slowly add in eggs and sour cream, then beat until smooth.
3. Take muffin pan out of the fridge. Divide mixture evenly between muffin wells.
4. Bake for 18-22 minutes. Cheesecakes should be firm but still wobble in the middle.

Ganache:

1. Put chocolate in a heatproof bowl.
2. In a small saucepan, heat heavy cream until it is simmering.
3. Pour over chocolate and let sit for about 5 minutes to let chocolate soften.
4. Add butter and stir until glossy. Let it cool slightly before spooning on top of each cheesecake. Additionally, sprinkle with powdered sugar if desired. Enjoy!!

3 minutes to God

So a friend of mine from Texas recently published a book of short anecdotal type stories and relates them to God. (http://3minutestogod.com/) I didn't think I would like it, but I really enjoyed it and hopefully will enjoy sharing it with others.

I don't buy into the entire religious part of the book, but it was a wonderful insight into the man I respected and appreciated as an influence on some of my 'better' times as a teenager.

With his book, he requested stories he can use in his next book. 300 words or less (which I thought would be plenty, but several edits later, I was ok with a 298 word version of what was originally probably more than double that....)


So, I figured I would share it here as well... along with some commentary I added afterward in the email.

20 Minutes In the Emergency Room I'll Remember Forever

Abdominal Aortic Aneurysm or “triple A” is a weakened spot in the large blood vessel that supplies blood to everything below your chest. That’s what was coming by air ambulance… and it was leaking.The patient had to be stabilized as much as possible and the operating room was getting set up for the patient to go directly to surgery after we made sure he could survive the trip up the elevator.

He was awake. I don’t know why I expected him to not be awake, but he was. Something about that spoke to me directly and made me stop looking at him as a nurse sees a patient and instead looked at him as a beautiful, wrinkled, blue-eyed man who was alone in a big hospital where none of the faces around him were familiar.

Chaos around me; people collecting blood, checking his heart rhythm, his blood pressure, and other necessary but impersonal tasks and never in my life have I felt that need to simply ‘connect’ with a patient. I spoke with him, made sure he didn’t have any pain or any needs that I could manage immediately, and I straightened his hair and made sure I talked directly to him with calmness in my voice and a smile in my eyes.

He was dying. It was evident from the mottling in his skin from where the aneurysm had leaked into his body. He was alone. His family was coming but weren’t as fast as the helicopter and all I could do was be the one person who looked at him, made sure he was comfortable, hold his hand and pray. I didn’t pray for a miracle, but simply for someone else to be ready when he got there to hold his hand instead of me.

Without the title.. it was 298 words after much editing and re-editing and all... but I hope you at least get a feeling of a little of what I felt... to know a complete calmness and understanding that I was doing exactly what I needed to do for that patient at the time.

The patient did not survive the surgery, and the surgeon did come back to ER to tell us that "it was like Mount Vesuvius when I opened that guy up". Pretty vulgar and all I could think about was how much I really think that advances in medicine sometimes.... well, maybe interfere with the way things are supposed to be. Don't get me wrong... I think there is a plan for everyone... including those who advance the capabilities of doctors and surgeons to prolong our time here, but there are times when I seriously wonder if people like this 80-something year old aren't missing out on better ways to leave this path of life.

I know I wished that I could have been a family member instead of a nurse who was there with him, just one familiar face in the craziness.... but maybe that's why I ended up where I am today, so I could be there and can do things like that in order to make things a little easier.

Another blog about work... cause I can't sleep

If you asked me what it was like being a nurse, I'd tell you it’s like being a waitress, a drug dealer, a housekeeper and a mother all wrapped up in a highly educated package. You constantly get bombarded with questions from patients, physicians, family members, other nurses and every other kind of ancillary staff present in a hospital. You take people food and beverages when they're allowed, explain to them why you can't when the doctor wants to keep them from eating or drinking, and hope that you can find something more than graham crackers and juice for the people who "haven't eaten anything in three days" because they've had a stomach bug with lots of nausea and vomiting. (Then you hope like hell they don't throw it all back up... because you're the one who's going to have to clean it up.)

You get to give some people some really good drugs. Not just narcotics or other pain medications, but when you think about it... things like Tylenol, Motrin, nausea medications and other non-narcotics are pretty awesome. Most people don't think so because somewhere along the way, someone decided that the stuff you can get over-the-counter just isn't as good as something you could only get in a hospital. Don't get me wrong, there are some really really good drugs you can only get in a hospital, but when you think about all the benefits of two Tylenol to someone with a fever it’s pretty awesome in the whole scheme of things.

I spend a lot of time writing as a nurse. I would imagine it’s the same just about anywhere because the mantra pounded into your head as a hospital nurse is "if you didn't document it, you didn't do it". Totally understandable, I mean, I wouldn't want to be in a courtroom trying to prove that I did something in a 'my word - vs. - someone else' and not have it written down. I guess the flip-side of it all is, realistically, I could write down that I did something when in fact I really didn't do it... I would never do that of course, but just sayin' its plausible. In my opinion, too much emphasis is placed on what exactly I'm documenting and not documenting.

I also spend a lot of time cleaning. I can't even count how many times I wash my hands during a typical shift. Aside from that, making beds, cleaning rooms, picking up linens, supplies, and small messes left by others. Nurses are notoriously messy from my experience. Sure, you occasionally find one who's very meticulous in making sure everything gets to the garbage can in a timely manner, but I can show you a very neat person who will drop items on a patient's bed or on the floor when you're distracted with more important things…

Some days I really love my job, other days I think of all the other things I could be doing for the paycheck. I mean, who wouldn’t think about doing other things when you have your hand somewhere very private trying to put a catheter in someone who hasn’t washed that area very well in a long time. Blech! Now, imagine that the person hasn’t washed because they weigh almost 700 pounds and you have to have 3 people help you even find the right area to put the catheter…. Yeah, seriously really happened and all you can do is ‘poke and hope’ and repeat over and over “I love my job. I love my job” ad nauseum until you find another task that hopefully gets your mind off what you just had to do…

What amazes me are the crazy things people will do to themselves. Sure, you hear stories about people putting things in or around their genitals…. Thinking to yourself the entire time, there is no way that is true… and then you get the pleasure somewhere in your nursing career where you meet someone who has done something similar or worse than the stories you’ve heard from other people. Deep sea fishing bobber that had to be removed surgically, homemade cock-ring that the nurse had to borrow the bolt cutters from the maintenance department to finally remove, people who swallow nails… and I don’t mean little ones you’d hang a cheap poster with, but three inch construction nails…. People who swallow double edges razor blades… all have been patients in the ER where I work. Seriously… like I have seen the xrays personally. People are crazy.

That’s probably not the politically correct term, but I’m sure just about every ER nurse who works in a metropolitan area can attest to the fact that some people are just crazy. Mentally disturbed, whatever. Again, some of those who can either make your shift supremely entertaining or one you swear will never end because you know you’re in your own little personal version of hell.

Other nights, it’s smooth sailing. No psych patients, no pediatric patients… just run of the mill abdominal pain, chest pain, minor trauma, or ‘out of my prescription’ patients. Those nights are the hardest to remember, but man… when you can have a good idea what they’re going to require during their stay, so you can shorten their length of stay in the ER and continuously flip your rooms… the shifts go so fast! Always know when the time flies, cause my charting is never caught up and I’m digging through napkins in my pockets trying to find the little notes I’ve made to keep track of what happened so I can chart it later.

It’s funny, I always tell my new nursing students that I hope they learn a lot while they’re with me, but if they take any lesson from me… learn to chart real-time, because when you get behind… it’s hard to catch up! Your rooms stay full… you do so many things you have to make notes or at least write something somewhere so you’ll remember later on… and when the pace never slows… you are discharging patients and then documenting two or three hours later. Some nights, I seem to be able to keep up; other nights I can’t even imagine how atrocious my handwriting gets cause I’m half scribbling just trying to get it all down before I have to start a new chart on another patient.

Faith

Heaven is for Real: A Little Boy's Astounding Story of His Trip to Heaven and Back

Its sort of funny in a way, but I hope that heaven is a place with no physical or time boundaries.  You can be, do, live, go wherever you want to go with the only limit being your imagination. If you grow bored with one place, you can just go to another. You can access limitless ways to identify yourself and experience anything you want with an absence of time. You can sit in a 15th Century castle as the last brick is placed, you can be there when a loved one passes over and join them on their journey, you can go back and sit with family you have lost and just enjoy their company again. You can change any moment, create new moments, experience everything you've ever wanted and take everyone you want on that journey with you. You could live a perfect moment every moment forever.

 

Remembering patients

Aside from all the ranting I can do about some of the patients I see, I love being a nurse. I love being at the bedside, doing things to help make people more comfortable and taking care of things that they are unable to do for themselves. I enjoy meeting new people, even on what could be the worst day of their lives to that point, and seeing them depart to either continue care as an inpatient or to go home with their process of healing started.

I see all kinds of patients, from the ages of days old to a century old… and they all have a spot in my memory somewhere and a typical patient is one I remember fondly. Sure, they don’t all have happy endings… and there are times when I wish I could go back and say a few more things to some of them, but for the most part, I know from experience that I do as much as I can for the time they are in the department.

My youngest patient was a little guy who was born on a rescue stretcher before we could even get mom to a hospital bed. It sure makes your heart race a little when you don’t work in a place that delivers lots of babies. He and mom both did fine and were transferred quickly to the post-partum unit of the hospital.

My oldest patients have been over 100. A surprising number of them have been alert and oriented. Knew who they were, who the president was and why they were at the hospital. Usually the older patients are in an ER for falls or changes in their mental status. You’d be surprised at how many little old ladies are suddenly crazy because they have a urinary tract infection.  Let me tell you, I’m glad some of them aren’t very strong… I’ve been smacked by more little old women who don’t understand why I keep bothering them. Poking them with a needle or lifting a breast to place EKG stickers will sure get their attention in a hurry even after you'd tried to explain what you’re doing before you start.

Unfortunately, the memory works in a funny way… because you can’t just pick and choose who you remember as a nurse. Usually something will stand out and will jog your memory if you can associate it, but by and large… I don’t remember a lot of the non-emergencies or generally cordial patients. Sometimes I’ll remember a face or a diagnosis, other times a family member, or even a discussion about an event. Other times, you can look at me and know that I was your nurse on a previous visit and I have absolutely no recollection of you or your visit. I wish I could remember everyone, but with the amount of patients I see every day, it’s probably a good thing I don’t.

There are some I remember by name or face that I avoid getting into my rooms at every opportunity. One in particular was a drunken man who had come in and was just awful. He was rude, even as I did everything I could think of to make him comfortable. He was a difficult IV start… and he left abruptly and was very aggravated. That’s all I remember. But, I do know that as I watched him leave, I vowed that if I ever saw his name on our tracking board again, that I would avoid being his nurse if at all possible. Generally, even the upset patients aren’t ones that stick in my memory... but he was just awful enough that I knew I would have a hard time being nice to him if he ever had to return. Don’t get me wrong, I would treat him and do everything I could to make his stay as pleasant and as comfortable as I could make it if I would have him as a patient again. I just would prefer not suffering through a repeat performance if at all possible.

Then, there are the patients who you know you’ll never have again because they’ve passed away, that you wish you could spend just a little more time with. I remember a gentleman that I helped care for when I was a fairly new nurse. He wasn’t my patient as assigned, but I spent a great deal of time with him assisting the other nurse. He was cordial, had a great sense of humor, and knew that he was dying.

He had a rather non-descript history. I don’t remember anything that struck me as something that was immediately concerning, but just things that arise from being a middle-aged person who hadn’t lead a very healthy lifestyle. He talked about his two sons, and wishing that they lived closer so he could see them one last time, and he talked a little about his father and brother who had both died at the same age the patient was currently. He was generally doing well as far as his condition for the most part during the ER stay, but he would have these severe and unprovoked episodes of shortness of breath. Increased oxygen, repositioning and breathing treatments resolved the episodes as they occurred, but they continued to increase in both duration and frequency over the course of several hours.

To share a little bit about an ER visit… generally, you are hurried in, we do everything medically possible to stabilize your condition, do all the testing requested by a physician, and then monitor you for changes while we wait for those tests to result.

We were at the waiting stage of the visit, and had increased the oxygen the patient was getting and continued to monitor him. He was stable, had decent vital signs and except for the oxygen mask, he looked relatively ok.  He kept making reference to being aware that he would never leave the hospital. Now, I was a fairly new nurse at this point and I couldn’t understand how this feeling of “impending doom” was a bad sign that most experienced nurses would tell you was really just that… a bad sign. I remember talking to the doctor about it…. The doctor expressed increased concern and went to reassess the patient, but there was still no change in his condition.

The patient continued to talk to the staff members, talking about his family, etc. Then, for no obvious reason, even with the oxygen on and after not talking for a little bit, he started to have severe difficulty breathing. We moved him into a “trauma room” (at this particular hospital, there were 2 trauma rooms, and while they had more equipment at the bedside, you would generally move a patient who was in significant distress to that room simply because it was bigger and more staff could be ready to assist if necessary without being cramped in a smaller area.) The move took about 30 seconds… since it was only about 20 feet from where we started, the only thing we had to do was hook him to portable oxygen, take the monitor out of the base and carry it along, and move his entire stretcher… so it was very little change for the patient other than the scenery. We repositioned him after moving, situated him to the call light, the changes in the room, and his breathing improved and he seemed to be doing better. He never complained about any pain, even when prompted, and his vital signs stayed within normal limits while he was on the oxygen.

Then, with no warning at all, much with the previous episodes, his breathing rapidly deteriorated and this time wasn’t improving with increased intervention. We had talked about interventions he wanted done, should something happen, and we immediately started the process of CPR (cardiopulmonary resuscitation).  We started helping him breathe with a special mask and bag attached, and gathering the necessary supplies to put a tube into his lungs so we could put him on a ventilator.  As we gave him medication so the procedure wouldn’t be painful and another to hopefully give him amnesia of the event, we laid him back on the stretcher to intubate him.

As we laid him flat, his heart stopped beating. We then immediately checked for pulses, found none and started chest compressions. He was subsequently intubated, and we performed chest compressions and gave medication to try and revive him. Our attempts at reviving him were not successful. We did CPR for a long time on that patient…. After he was pronounced dead by the ER physician, we talked about his visit. A sort of ‘after action report’ at the bedside and discussed things we may have done differently. No one could think of any intervention that we didn’t try and I think that was the first time I ever felt helpless as a nurse. There was just nothing apparent that we could have done differently to save that man’s life. In retrospect, after reviewing the tests that were done (and had not been resulted by the time he was moved to the trauma room), he had apparently had several blood clots throughout both lungs. There are things that could have been done differently, in retrospect, using a blood thinner like Heparin could have prolonged his life, but as with everything related to medicine, there is no guarantee it could have worked at all.

I will never forget that patient. I don’t remember the jokes he told, other than they were ones I had heard before and they were very corny - he thought they were quite clever though if you could judge by how many times he told them and how many nurses he told them too. But I will remember him talking about his family, his son in college and another who had just gotten a new job and had made his dad so very proud. Its knowing that you are their family when the other can't be there that makes nursing worthwhile sometimes. You are their support, their caregiver, their confidante, their advocate and their hope. Spending the last few minutes with someone is unbelievably difficult and unbelievably humbling.

Ranting RN

I work in an Emergency Room that is usually full, has a long wait time and what you would think were the unhappiest patients on the planet, according to my manager. I know this is far from true, but I get so tired of hearing about “patient satisfaction” and reimbursement based on recommendation that I just feel sick to my stomach. People are entitled to the care, compassion from the caregivers and the best treatments available. I firmly believe that anyone who is legitimately sick understands how much a healer is willing to do to make sure they’re taken care of and comfortable.

That’s the dilemma, we see so many people every day who have no business being in an emergency room, because they have no emergency. Back pain you’ve had for six months, a toothache, and an inability to remember when your last period was while you’re sexually active…. Yeah, they’re all horrible to the person who’s experiencing that loss of control, but certainly not emergencies. BUT! There’s more! They are entitled to the same level of compassion and concern as someone who is dying, someone who has a broken bone, an impaled object in their body, or are losing control of the ability to breathe without assistance.

You might say I draw comparison to extremes, but when the 80 year old man who is dying is going to get a little more of my time than a 40 year old with back pain. Just how it is… And guess what… the grumpy jerk that ‘was in a car accident a year ago and is out of his pain pills’ is going to be the one who writes the comment card or speaks up about his experience when someone calls his house to see how his visit was in the ER.  It wasn’t as good as it could have been, but a visit to his pain management clinic or primary care doctor would have been a lot less painful for everyone. Probably would have been his choice… but wait, his doctor fired him as a patient because he was non-compliant with his other medical problems, and the pain management clinic was raided by the police last week and is now closed. Ugh!

Definitely a society and cultural problem going on today… people selling Lortab on the street, ‘getting medication from a friend’, knowing what Dilaudid is when you don’t have a chronically disabling condition. Being allergic to every non-narcotic pain medicine, bringing a friend with you because you know you’re not going to get narcotics unless you have a ride, telling someone you go to the ER because its “free”, or a myriad of other things that irritate ER staff… in other words, knowing how the system works and how you can get around it.

Triage. That word means, very basically, to sort. In the ER, you get triaged twice whether you realize it or not. You get triaged when you get there, they ask you all kinds of personal questions about why you’re in the ER in the first place… what kind of history you have, and try and get a general sense of how urgent it is that you see a doctor. Usually you get assigned a number that corresponds with your expected treatment, and that puts you somewhere on the list to get back to an actual room to see another nurse and a doctor. The part you don’t realize is that you’re triaged again when you get to the room. The nurse who comes in to see you, usually hooking you up to monitors or drawing blood, asking a few questions and generally getting an idea of your mental state, how you appear, and just an idea of your demeanor is your second triage. That nurse then puts you in his or her own personal triage relative to the patients they have in the other rooms they are assigned. If you look legitimately ill, your vital signs are not normal, or you present yourself in a way that rings alarm bells to a nurse, you go higher on the priority list. 

That second triage is probably more important than the first as far as how ‘satisfied’ you’re going to be as a patient. If your nurse builds a rapport with you, believes you are actually sick enough to require emergency care, the more likely it is that the physician is going to arrive to the same conclusion. It’s also more likely that the little things that would make your stay more comfortable are going to happen more expeditiously than if you are someone who doesn’t appear to have an emergency.

In other words, you will see the doctor sooner rather than later, if the nurse is concerned about your life, limbs, mental or general health.  If you have no obvious signs of distress, trauma, abnormality or other concern, you go lower on the priority list for care. Not to understate the obvious; everyone in an ER will see a physician and be treated based on the physician’s medical judgment. Regardless of where the nurse puts you on a priority list they have internally, there is room for adjustment when and if it’s necessary.

A piece of advice: Being a jerk, telling me your pain is ten out of ten on a numerical scale or writhing around the bed and ‘carrying on’ is not going to endear you to anyone in the department. We’ve seen it all and our bulls&*t meters are probably better attuned than any others in the world. We know what pain looks like, not just what you say it is… and if you start at ten… and then it gets worse… how are we going to know by a number? We’re not. BUT, we are going to see changes in your affect and demeanor that suggest it has increased. If your pain is so bad that you feel medication may be necessary to treat it, start at six or seven. That way, if it does get worse, there is a number that will correspond and we will have a quick reference to whether or not any treatment is working. And, while I agree that everyone’s pain tolerance is different, telling a nurse that you have a ‘high pain tolerance’ only suggests that you have or have had an addiction to pain medication. I’m not saying everyone does, but it’s a red flag in the back of the mind when someone says to a nurse “that dose isn’t going to work” before you’ve even been given the medication.  Unless you’re a cancer patient, someone with a crippling disease or some kind of weird metabolic thing that affects pain management, having an idea about medication doses is another flag to anyone working in an ER.

Another piece of advice: if the ER staff knows your name before you tell anyone what it is, may be an issue. There are at least five names I can spout off at any given moment that belong to “frequent fliers” in the ER where I work. The worst part of this, is I probably know their medical history better than their significant others, and some people don’t believe this is a problem. Seems to me, that a primary care physician and their office staff should be the ones who ‘know you on sight’… not the staff in an ER. What’s even worse is when the rescue people don’t have to get directions to your house. Maybe it’s time for a lifestyle change, because something that’s going on in your house is not healthy. 

I realize that some people have no other place to turn to for care. I know that every population has those people who cannot or will not use resources in a way that is beneficial to everyone. The ER is not free. If you’re not paying the bill; many people, including the ones who are taking care of you, are the ones paying for it. Nothing is free. Someone is either writing it off as ‘charity’ or you and those who are doing the same are costing the hospitals millions of dollars in revenue that would be more beneficial in other ways. Think about this, if a hospital was to take all the money they ‘write off’ they could probably build, staff and maintain a clinic that offered care at little or no cost for those non-emergencies you have at 10pm on a Wednesday night because there is nothing you want to see on the television and you ran out of Percocet. 

The Story of Wiggles

Wiggles was the troll. She mostly camped out under the bed and harassed anyone or anything that entered her territory. A little terrier mix, she was the queen of the house. Alpha dog... the one who made the most noise and all of the decisions about her schedule. She decided when she was going to be outside, and most definitely let you know when she was ready to come inside. When she wasn't being the troll, she would lay in the yard soaking up the sunshine like there wasn't anything better in the world at that moment.

She didn't like to be picked up, she hated the grass when it was wet, guarded a rawhide like it was the only treat she was ever going to have, and had to be muzzled to get her nails done.... cause she'd growl and act like she was going to bite whoever so much as thought they were going to trim them.

She never bit anyone that I'm aware of, but when she was upset about someone being in her space or invading her domain, you had no doubt she meant business.

She would smile at you when you acknowledged her, she would prance and dance in front of you to get your attention and then run away to hide under the bed once she knew you were watching.

On Sept 2nd, she was being aggravated by the great dane, Asia. They routinely had routs where Wiggles would assert her authority and Asia, in her 'dopey large happy dog, I must be the center of the world' way, would chase Wiggles until she got under the bed. Fortunately for Wiggles, Asia outgrew the ability to fit under the bed at about 4 months old. As they ran past the chair and into the bedroom I heard a horrible yelping... A noise I'd never ever heard Wiggles make. I immediately went to see what was going on. When I looked at Wiggles, she was seated with her butt on the floor, running in place, cause her little back legs wouldn't hold her up. I grabbed her little body and felt for a broken bone, a dislocation, or something to explain this sudden, and horrible to watch, change in her body.

Not feeling anything obviously wrong with her, I grabbed my cell phone and called the veterinarian that Wiggles has been to routinely for the last 14 years. They said the doc would be able to see her if I could get there in the next 10 minutes. I grabbed Wiggles, and a 'oh my god, can traffic go ANY slower' and 'please don't make this little dog any worse while I'm on my way to help'...'please don't let me get into an accident while I'm holding Wiggles and trying to call my husband at the same time while driving'...  We finally got to the vet.

I think I was too panicked to cry up to this point, right up until the vet tech wanted to weigh Wiggles... and I sorta broke down when I tried to tell her that Wiggles was unable to stand. We waited maybe 2 minutes.. and the vet came in and did a short, but pretty thorough, exam.

Did you know... there is a veterinary neurologist... yeah, I didn't know that either until we were told that short of taking her there, our vet wouldn't be able to do anything to help Wiggles at that point in time. Telling me that little dogs sometimes herniate discs in their spines and that a neurologist would be our best chance at fixing what was going on.

Another phone call to my husband, some short and concise directions... and Wiggles and I are back in the car driving through more "slow as molasses" traffic to get to the veterinary neurologist's office.

About 45 minutes have passed since the yelping...

We get into the office, get Wiggles weighed at this office (15lbs)... and get to the exam room. A tech comes in at first... who I'm sort of frustrated with, because she didn't identify herself at all when she walked into the room, so I didn't know if she was the vet or a tech or what.. and didn't know until the actual vet came into the room a short time later. (Thankfully by this time, my husband had arrived and was in the room with us.)

The neurologist did an exam, including reflexes and assessing the amount of feeling Wiggles had in her body.

Pretty much, no sensation in anything from mid-back to her tail, and just watching him squeeze his hemostat (medical pliers essentially) pretty tightly onto her little toes was just about more than I could stand to watch.

Then we get down to business. Wiggles has suffered a spinal cord injury, sometimes common in little dogs, but the prognosis was 5 on a scale he described... with 1 being best case for recovery and 5 being the worst. (1 - they have 'drunk' appearing hindquarters, but still have feeling in the back legs and tail, 5 - they have no sensation in hindquarters and tail and have lost function.) So we then start to talk about options.

Option 1 - we do all the testing, see if they can determine what exactly is going on, CT scan, myelogram, MRI maybe, and then surgery if its possibly a problem that can be fixed. All to the tune of about $5000. The vet said best case with Wiggles would be a 50/50 chance that she would be a candidate for surgery and he could prolong her life. But there is a 10% chance with all spinal cord injuries in dogs that it would progressively worsen over the next few days and even if they did everything, she would continue to deteriorate until she ultimately lost the ability to breathe.

Option 2 - we wait and see what happens over the next few days. They will hook her up to IV fluids to keep her hydrated and 'fed', and in all likelihood, any chance at the surgery being successful would be lower because the longer you wait with any injury like that, the possibility of good outcome decreases. By his body language and repeated reference to the cost being close to that of the surgery, you could tell the vet did not like this option.

Option 3 - stop. He wrote that word on a white board in the room and circled it. (don't get me wrong, he wrote all the options on the board and then discussed with us the pros and cons of each one) but he underlined the first, and circled the 3rd.

Let me give you a little background about my history with pets. I think we had a pet in the household for almost all of my childhood. Mostly dogs my father used for hunting (if they were smart enough to retrieve) and some who were just dogs that needed a home. There were no trips to the veterinarian that I recall (except for shots probably), but if there was something wrong with it, it wasn't anything a shotgun after a trip away from the house couldn't fix.
I don't think it was inhumane in any way, but more the result of a household who couldn't afford hundreds of dollars in medical care for an animal. You could probably argue that a household who couldn't afford medical care for a beloved pet probably shouldn't have had said pet to begin with, but I assure you, those animals were loved just as much as those who are carried around in handbags and taken to salons.

Now, being the grown-up and having to make that decision regarding a pet is totally different than someone else making that choice.

So, back to the neurologists office...

I know in my heart that the little dog that is Wiggles; named such because when she was happy, her little tail would wag so hard that her whole body would wiggle, would not be a happy dog if she couldn't be the troll under the bed. We talked about little carts to hold her back legs for her, the need to learn to help her empty her bladder, and that it may be difficult to even encourage her to eat over the next several weeks. We talked about watching her for a couple days and seeing if anything changed, and we talked about option 3.

I asked the veterinarian if he could do just a plain xray there in his office, which he did, and my husband and I talked and cried while they did that...

Returning from the xray, Wiggles was still the same. Panting and getting all worked up when we moved her, but then settling in some once I found a comfortable way to hold her.

Didn't know that dogs "postured" with spinal cord injuries. The vet sort of talked about that a little bit while he was there and she did it. She'd lay her little head back, hold her little front legs straight out and it was the only time, since before the injury, that she wasn't trembling. I never got the impression, except for the first few minutes when I heard her,  that she was in any pain. I suppose if you don't have any sensation, there is no way its going to hurt...

The xray showed a vertebrae (a bone in her spine) that was about 2/3 the size of the surrounding ones. The vet explained that it was not an obvious fracture or herniation, and could have very well been there since birth, but his "I've been a vet for 20 years gut feeling" was that it was probably pathological. In other words, it was most likely deterioration from some form of cancer. Without doing a CT scan or MRI, most cancers aren't visible on an xray unless they are bone-growths. Now he tells us that the prognosis would be significantly different if it was cancer that had caused the bone to deteriorate like that. At the most, probably 6 months even with surgery and treatment. He explains again that he can't know more without further tests.

We talked a lot about those tests.... the benefits, risks and outcomes associated with them. The vet explaining that unless we're willing to do surgery, there is no real reason to do the testing. They can cause their own problems, and while we'd have a more definite answer as to what had actually happened to cause Wiggles to have a spinal injury, there was no benefit at all if we weren't considering doing everything in option 1. And, also the likelihood, that if they did the myelogram or other invasive type procedure, that the best choice might very well be to just not wake her from the anesthesia when the test was complete. There was also a very real possibility that we could do all the testing he had discussed and still not have a definite answer.

Now, I cried more in those few hours than I've cried in the past several years. I knew that the best thing that I could do for Wiggles was to make sure that she was as comfortable as possible and hope that there was a heaven for dogs and that she would be happy there. Keeping her alive, unable to chase things in the yard, unable to be the troll under the bed, and unable to even urinate completely without help would take away a lot of what made her Wiggles.

We went round and round, talking with the vet about expectations, choices, outcomes, risks. And I swear that man had more compassion and understanding than some of the people-doctors I have met in my lifetime. He was forthright and completely left us to the decision after giving us all of his recommendations.

I think the hardest part of the entire day was watching my husband take off her little collar, give her a kiss and a pet, and after I did the same, handing her to the vet knowing I would never see her again.

Today I wish I would have spent another 5 minutes with her... just loving her, telling her she was the best little troll in the whole world... and holding her. My only consolation, is that I know she knew we loved her.. and had I taken another 5 minutes, I would still wish for 5 more...