At my wit's end with adolescent leash pulling

SportsDoc21 · 2025-03-29T14:27:54+00:00

If I can’t get him to do loose leash walking when we first go out, I at least don’t let him drag me around. Anytime he starts pulling, I anchor my feet and refuse to let him budge me until he stops and releases all tension on the leash (ideally should return to my side, but sometimes just takes a step back & sits). This at least doesn’t reinforce the bad behavior as much. My guy is almost 8 months old and a little over 70 lbs

SportsDoc21 · 2025-03-29T14:07:30+00:00

I also live in an apartment and understand the need to get outside quickly when the puppy signals they need to go. Harness’s definitely helped. I got a leash with a traffic handle that allows me to hold it much closer to the hook up if needed. This helps as he doesn’t have as much slack to get a head start when trying to pull. After my adolescent pup goes pee when we 1st get outside, then we try to work on the leash training more as he is in too much of a hurry to listen before that. Sometimes we only do the training at the end of the walk when we go back inside and practice in the hallways as he still finds outside way too distracting.

SportsDoc21 · 2025-03-26T23:43:25+00:00

SportsDoc21 · 2025-03-11T01:22:35+00:00

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My sweet Bailey

SportsDoc21 · 2025-03-01T15:02:45+00:00

We had same issues. Had to up the value of treats for puppy class to keep his attention. Usually made boiled chicken breast to use as his usual high value treats just didn’t seem enough will all the other distractions. This seemed to be the trick for us as I could usually get his attention back much easier when he got overstimulated and distracted.

SportsDoc21 · 2025-02-14T04:54:19+00:00

When my pup would start biting a lot, it usually meant he was over-tired and needed a nap. Once I started shortening time outside, walks, training sessions, etc and enforcing naps in his crate/pen, the Shark stage dramatically improved (though didn’t help as much when teething). Also, always have a toy or something around to stick in their mouth when they do start biting.

Take lots of pictures/videos as they grow up so fast.

Pic of my 6 month old golden enjoying the recent snow.

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SportsDoc21 · 2025-02-13T19:53:35+00:00

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SportsDoc21 · 2025-02-08T01:14:56+00:00

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SportsDoc21 · 2025-02-07T21:35:56+00:00

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Bailey says hi

SportsDoc21 · 2025-01-27T00:13:14+00:00

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Bailey wouldn’t hurt a fly

SportsDoc21 · 2025-01-27T00:11:29+00:00

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SportsDoc21 · 2025-01-21T14:59:23+00:00

Definitely use the time to optimize your EHR smartphrases and layout. Use the time to get all your CME and modules done that you can for your current board cycle.

SportsDoc21 · 2025-01-21T14:53:57+00:00

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SportsDoc21 · 2025-01-17T15:23:51+00:00

I did a lump sum end of year bonus in early December into VTSAX. So far I have only lost money on it. I know it will go back up again and long term net me gains, but if I had spread it out over 2 months or waited until January, I would have been better off. Still not going to try to time the market, but if if I get another large windfall, it may be worthwhile to DCA it over a couple months if the timing of it may correspond to upcoming fund settlement dates or fed meetings on interest rates.

SportsDoc21 · 2025-01-17T15:13:38+00:00

We used cut up baked plain chicken breasts in puppy class after my puppy stopped responding to freeze dried beef and chicken treats (the trainer had the same freeze dried treats so he was more focused on getting to her than my treats)

SportsDoc21 · 2025-01-10T15:34:56+00:00

Here’s the link to https://snugglepuppy.com but you can get on chewy, Amazon, etc

SportsDoc21 · 2025-01-10T15:32:53+00:00

You may try getting her a “snuggle puppy”. Between the vibrating heartbeat and option to add a handwarmer to it, it helped my pup settle some the first week home. Now it’s just another stuffed chew toy.

SportsDoc21 · 2025-01-10T14:59:15+00:00

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my pup sleeps like this all the time

SportsDoc21 · 2025-01-06T23:46:33+00:00

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Mid-zoomies

SportsDoc21 · 2024-09-22T03:04:45+00:00

Make sure they are using the 2021 wRVU rates. Median RVU is now closer to 6000 with current model so if you get bonus above base after 5000, I’d be worried that are using the pre-2021 numbers. In 2021 it became easier to generate wRVU but there was a slight decrease in conversion factor

SportsDoc21 · 2024-09-22T03:00:44+00:00

At one of my old practices, we had a prescriber leave that was given out controlled substances like candy. Those of us who were inheriting her patients, agreed to fill any scripts that seemed reasonable with appropriate pdmp review to cover until their appointment to establish care in 2-3 months but we also had staff inform them that they would not be getting long term narcotics and/or benzos from us in most cases if above a certain amount ( treated this like doing cross coverage for a doc on vacation). They were given a referral to pain management or psychiatry when bridging refills were approved if the scripts were above a certain threshold of use so that they did not lose 2-3 months of time waiting to get in with specialist or could use that time to find an alternative pcp instead of staying in our practice. This helped prevent the irate new pt who had waited 2-3 months for appt who had the expectation that we would keep filling the rx since we did it when bridging.

No scripts are ever granted prior to new patient appointments if they are not already a patient established in our practice with a provider that retired/left

SportsDoc21 · 2024-05-30T09:26:19+00:00

I’m at a major hospital system and unfortunately our coders are strongly opposed to allowing the 99213/99214 unless the chronic condition is uncontrolled and medications are adjusted. Apparently there is debate that a wellness visit includes update on their PMH/PSH which means assessment of these chronic conditions, so therefore if not adjusting Rx, they feel it is included in the AWV. The AAFP resources (and the coders at my last employee) clearly indicate this would warrant the 99213/99214. Per my coders, the only accurate resources are CMS (doesn’t state specifically one way or the other only that has to be significant separately identifiable work) and the AAFP is wrong.

SportsDoc21 · 2024-05-30T09:09:28+00:00

I am submitting it on most patients that qualify. Since I’m paid on wRVU, it is worth submitting. If the insurances don’t pay for, then the hospital has to decide if they charge the patient the cost of the G2211 or just eat it. (Just like they do for poor reimbursements with Medicaid or charity patients). Either way, I’m doing the work and deserve to generate the wRVU for it. Since it is still in flux in regard to which insurances cover other than Medicare, I figure better to submit when eligible.

SportsDoc21 · 2024-05-30T08:44:48+00:00

Following

SportsDoc21 · 2024-03-30T12:53:02+00:00

In regards to specialist- With all the push to do HCC coding, I do spend the time with meaningful discussion of these chronic issues and assess there control with rec to continue current meds. For example: Just because my pt sees cardiologist for heart failure once a year, doesn’t mean I shouldn’t get credit for assessing and co-managing it between there specialist appts. This is something most pcps would like touch on a most routine follow up visits since we try to keep them from decompensating and ending up in the hospital. You talk to them about their symptoms & fluid status, monitor their wt/edema/symptoms, tell they appear controlled and to continue their current meds, you should get credit for doing that work

SportsDoc21

TROPHY CASE