Monday, December 22, 2008
Had a lot of variety today. Some mammary tumors in a dog that have thankfully not gotten to the point where they are large and necrotic. Science tidbit- if you spay your dog before her first heat cycle there is a 0% chance (ok, maybe 0.0003456%) of her getting mammary adenocarcinoma, versus no reduction in risk if she's spayed after her second heat cycle. I know people are saying, "But I want to breed her!" That's a whole 'nother different post, but if you know you're not going to breed your dog, just spay her early! You'll save yourself pain, heartbreak, and money later on.
I just saw a little dog who likes to eat squirrels, and she had HAIR caught in her teeth. Along with some of the nastiest tarter and bad breath I've seen in years, and that's saying a LOT. Yuck... don't let your dog eat squirrels or other small mammals.
Puppies are fun, but when it's 24 weeks old and growling at you when you walk in you know there will be trouble later...
Should have a good horse post later this week. Boy, it sure is cold here!!!! Stay warm ya'll!!!
Monday, December 15, 2008
This is what I told Mrs. L as I lead/pull Fluffy to the back. Fluffy and I are old foes, and I prepare myself mentally for the battle to come. Fluffy starts growling as I lead her past the double doors marked, "Employees Only." A lot of times dogs are calmer and less likely to be mean once their owners are out of sight. Many times I've taken a snarling, growling Chihuahua into the back away from it's owner and had a nice, easy physical exam and shots and been done. No so with Fluffy, however. With Fluffy it's all out war.
Fluffy is a cocker spaniel, and she has lots of people fooled. With her cute blond head and soulful brown eyes, she is the epitome of doggie innocence. However, bring her to the vet's office and she turns into a black belt of doggie ninja, the all four feet and teeth menace that is every vet's nightmare.
I take Fluffy into the back room with about three assistants and tell one, "Close the door." The instant it's closed, one drops a towel over her head. This serves many purposes, the main one being so she can't see to aim. Every time somebody touches the towel she tries to turn and bite it. While one assistant distracts her with a touch to the butt, another grabs her around the head and puts her in a cradle hold. The third quickly whips the towel away from the mouth and gets a muzzle around her nose. She snaps the muzzle and half the battle is won: she can no longer bite. She looks at us with brown eyes of ice as horrible sounds of retribution emerge from her closed lips. She keeps up a stream of growls and yips. If she could talk her owner would have washed out her mouth with soap.
I tell the assistant holding her head, "Ok, time to flip her." With most dogs the muzzle controls their main weapon, the mouth. Not so with Fluffy, Fluffy at one time studied doggie ninja with a cat, and her scratches hurt almost as bad as a cat's can. The assistant holding the head gets hold of the front legs and another assistant grabs her back legs and we flip Fluffy onto her side. With her head and all four legs pinned, she starts wiggling and peeing, pooping, and expressing her anal glands in protest. If you've never smelled anal gland, be thankful. This is a hundred times worse than the nearest landfill.
The third assistant holds her middle as Fluffy tries to wiggle and hop off of the table. With her immobilized except for her noises I can proceed to that horror or horrors, that terrible fate awaiting her, that which Fluffy fights to avoid: I trim her nails. Very carefully I trim up to the pink part of her perfectly clear nails. Each click of the trimmers in accompanied by further doggie invective as I, *gasp* actually touch her feet.
"All done," I cry triumphantly, and my faithful minions let up, the last one whipping off the muzzle as she lets go. Fluffy makes a few goes for my hands, than bites at the assistant holding her leash. I gingerly take her leash and lead her back out front. I breeze into the room where Mrs. L is waiting fretfully, wringing her hands in anxiety. "Did she do ok?" she asks me, her cloudy blue eyes searching my person for bite marks. "Don't worry Mrs. L, she did great. No problem."
As Mrs. L goes to pay her bill, Fluffy looks at me over her shoulder. You can almost hear her thoughts. "I'll be back."
Thursday, December 11, 2008
My cat on IV fluids is hydrated and eating some on her own this morning, so progress is being made. We have this weird blend of busy and dead going on this week, after Monday's craziness today has only ONE appointment. Well, I can catch up on my blogging! Hope something not boring happens tomorrow!
Monday, December 8, 2008
Then I saw a sick cat and kept her on IV fluids.
A couple more appointments go by, nothing special. Than this dog rushes in about 4:30. His back foot is completely torn to shreds with shattered bone everywhere. It's bleeding everywhere and the foot is literally split in half. We start an IV catheter while the owner is contacted, manage to stabilize the dog and send him off to the emergency clinic 45 min away for overnight care. Tomorrow the owner will bring him to his regular vet for amputation.
Overall a pretty exciting day!
Friday, December 5, 2008
So I get this call about 10 pm while I was working overnight. It's this lady on the phone. "Oh dear, my dog is 66 days pregnant and acting like she's going to have puppies!" I ask some questions and determine, yes, she was bred on purpose, yes, she is showing nesting behavior, and yes, she does seem to be having contractions. So I ask, "So, sounds like she should be having puppies anytime now."
"Ok," she says, "I'm on my way!" "Wait," I exclaim, "why are you coming here?" She replies, "Well, I'm not going to let her have puppies AT HOME!" With that she hangs up, before my smart mouth can retort, "Well than, why did you breed her?"
She arrives about 20 minutes later with a charmingly under bitten foo-foo breed with long hair who is in active labor. I'm surprised she didn't start popping out puppies in the backseat of this lady's car. Course, that would have been pretty funny. I examine her, and take her in the back to ICU, load her into a cage with lots of comfy blankets, and leave her be. While I proceed to be swamped with other actual emergencies, she sits there, pants and stops contracting. Every five seconds the owners ask the receptionist about progress reports. I keep sending a tech up to answer them, and the tech tries to explain why the doctor is not coming up every time...
Three hours later, not a puppy to be seen. I was walking to her cage to scoop her up and send her home when OOPS! Out pops a puppy. I leave her to do her thing as I go out and tell the owners that she show is on the road.
Two hours later she has four new members of her family all wiggling and crying. I had had to help her break the placenta for the first one, but the others she handled like a pro. I palpated her abdomen gently and felt one other puppy in there. So I left her to do it.
Two hours later, she'd curled up to feed her brood and her Mom was breathing down my back more every second. So I popped her a little oxytocin, and our popped number five.
So off they went with their new little family, so proud and gushing thanks. "Oh, what would I ever do without you. If you hadn't been here, Fluffy would have had to have her puppies AT HOME!!"
I just stared at her as she walked out the door.
Thursday, December 4, 2008
Friday, November 21, 2008
Me: How big is the donkey and is he gelded?
Client: Well, he's as big as a freakin' house! And no, he's not gelded, I wanted him to protect my goats! I would never take away his manhood!#$%^&
Me: Well, if he's not gelded he's a lot harder to handle...
Client: I never handle him, so that's not a problem.
Me: But you expect me to stick him with a needle?
Client: Well, you can try! *laughs*
Me: What's the ferrier going to do?
Client: Dodge, really fast! *laughs harder*
What, a DVM is a degree in how to dodge flying hooves, stick needles in speeding objects, tackle my patients, get bitten, walk around in a haze of fur, oh, by the way, the x-ray processor is out can you fix it?
I should have been a plumber. They make more than I do.
Monday, November 17, 2008
It's not very often, however, that I feel like I should record the same talk to the same client.
This absolutely adorable little old lady has a dog who gets fed a little too much people food. This causes him to have gastritis a little too often and not eat. I saw the little guy the first time and put him on a short course of sucralfate and metronidazole. Metronidazole is a drug we use in low doses for it's intestinal anti-inflammatory qualities. Since this little dog weighed about 4 pounds I mixed the pills in into a liquid form for ease of administration and dosing. It taste's very yucky, however, and the client christened it, "That Yucky Medicine" or TYM for short.
I told her about five times during the initial visit what exactly TYM was for, i.e. "Now, Mrs. XYZ, I know it tastes bad, but it calms down the inflammation in the intestines..." We'll call this phrase 1 for ease of typing.
So later that day I get a call from Mrs. XYZ. "Now dear, what exactly does TYM do?" I patiently explain again Phrase 1 and she is happy.
Repeat the next day.
And the next day.
And the next day.
And the next day.
So she stops calling for a few days and I rest secure in the knowledge that her dog is feeling better.
Than she calls back. "Dear, Pookie ate a little chicken today and isn't eating. Should I start him back on TYM?"
"Yes Ma'am," I say. And repeat Phrase 1.
Now don't get me wrong. I really like Mrs. XYZ and she is as sweet and polite as she can be. But I feel like I can start my own record label. It'll be called MedicalGems and the lead track will be titled, "TYM and Mrs XYZ." I could make a fortune, and start a company to record all the usual "talks" that vets give their clients and same them the trouble.
You can than call me Dr. Can'tSpell, millionaire. Yeah right. And I can fly without an airplane, too. Zoom Zoom.
Wednesday, November 12, 2008
I don't do much surgery. Despite liking it in vet school I had a few terrible episodes right out of school involving huge obese dog spays with loose ligatures and some large pyos, and one memorable... never mind. So it's taken me about a year to get my surgical courage back.
Monday I repaired a prolapse of the gland of the third eyelid (say that ten times fast) using the pocket technique. I've never done this surgery and never even seen one, but went to an excellent CE conference this past weekend that taught me how to do it. It went really well and looked really good when I was done.
Today, I amputated a cat's ear. The inside of the pinna (the part that sticks up) had a nasty fast growing tumor on it that I've cut out once before. So this time, with the owner a little frustrated (understandable) we just cut the whole thing off. That was interesting, I've never done it before. Went pretty well, as well. We'll see how he does the next few weeks.
I also did a cat spay and neuter today. Same old same old, probably done about a hundred or so of those. Took me less than an hour to do both of them.
Hope I have something good to tell ya'll (I used that word on purpose) next time I blog!!!
Friday, October 31, 2008
If you have a dog, there are certain "things" that should be like routine maintenance on your car. If you have a car, you change the oil every 3,000(ish) miles, rotate the tires every 8,000, and occasionally get new tires, charge the air conditioner, etc. Right? The same is true for your dog. Ideally, the following schedule should me maintained.
1) Every year vaccinate against Lymes and Lepto if you are in a susceptible or at-risk area.
2) Rabies vaccine every 1 or 3 years, depending on type of vaccine. It's the LAW.
3) The "distemper" shot every 1-3 years, again depending on vaccine type. The vaccine everybody just calls distemper actually vaccinated for 4-6 diseases depending on vaccine. This usually includes Parvo, Adeno, and Distemper, also may include Parainfluenza. This is the one that gripes me the most, as puppies that go without this vaccine can get parvo and DIE.
4) Heartworm prevention every month. Heartworm is very preventable these days in an easy and relatively inexpensive format. Inexpensive compared to treating for heartworm, certainly. Just do it, idiots!!!
5) Flea control that works every month. Hartz, BioSpot, SpotOn, Seargants, flea collars and flea baths DON'T WORK, SO USE THE PRODUCTS THAT WORK like Advantage, Frontline, Comfortis, and a range of others that you can GET FROM YOUR VETERINARIAN. These will work, unlike that drek you get from Wal-Mart.
6) And for goodness sake, if your dog has been vomiting for three weeks, having diarrhea for a week, hasn't eaten in three days and looks like a bag of bones on a stick with sunken in eyes and drool coming out of his mouth, do NOT ask me to update his vaccines while he's here and give him a nail trim. He has OTHER issues, thank you very much.
Wednesday, October 22, 2008
Client: You know Doc, the police officer who lives behind me said he's been poisoned.
Hmmm.... your dog is vomiting and very skinny.
If I'd wanted to be a police officer, I could arrest people.
Client: You know Doc, my groomer said Fluffy has worms when he scoots his butt on the carpet.
Your dog's anal glands are full.
If I'd wanted to be a groomer, I would have taken an online course.
Client: You know Doc, my Aunt said that this is exactly what her dog did when he had Parvo!
Your dog is 3 years old and has had all his shots. Your dog has gastritis from the ham bone you fed him.
Well, I am an Aunt, but still...
Client: You know Doc, the teller at the bank said her dog gets terrible allergies every fall, too.
Gee, dogs don't sneeze when they get allergies, they get skin problems. Your dog has Kennel Cough.
If I'd wanted to be a bank teller, I'd have applied at a bank.
I can't go around arresting people, I can't groom dogs, and I certainly am not a bank teller. I am a veterinarian. I don't try to do YOUR job, so PLEASE don't tell me how to do MINE. I did, after all, spend a lot of money on *EIGHT* years of college. Though it would be nice to have a bunch of money to count all day...
Thursday, October 16, 2008
Thursday, October 9, 2008
I arrived on the farm to find my patient waiting for me. His owner has taken him for a little walk and let him eat some grass. He was pretty large, but not as big as a full grown one should be. He had pretty good manners for a stallion and let me examine him ok, but was a little pushy on the ground. I gave him his premedication and walked away to prepare the induction drugs and my instruments.
Castration in horses is in some ways a throwback to "the good old days." Most of them are done in the field under relatively short acting drugs, in this case Ketamine and Valium. My premedications were Xylazine and Butorphanol. When you drop a horse you have to take care the horse does not fall on you. Castration is accomplished with an instrument called, appropriately, an emasculator. This instrument simultaneously cuts off the testicle and crushes the cord it was attached to. This crushes the spermatic cord, the testicular artery, vein, and nerve, and the cremastor muscle that controls testicular descent and ascension. Usually there are no ligatures used. This instrument is left in place for 5 min. My emasculators do not lock in place but must be held in position. Remember this, it's important later.
I approached the horse and gave the induction drugs IV. These drugs are relatively short acting and give me about 20 min to do my job. The horse drops and we rapidly prepare him for surgery. The surgery site is aseptically scrubbed (as much as you can call surgery in the grass "sterile") and I made my first incision. It was remarkably hard to exteriorize the testicle, partly because of this horse's age and partly because there was a lot of fascia. It took me about 5-10 min to get the testicle out far enough to emasculate. While that one was sitting, I got the other testicle out. This one was a lot easier. After the 5 minutes, I applied the emasculator to the other cord.
I guess my 20 minutes was about to run out, because the horse didn't like me cutting his cremastor muscle. As soon as I got the instrument closed, the horse got up.
Horses getting up is a special nightmare in castrations. We're all told horrors in vet school of castrations where horses careen across the field trailing his bleeding spermatic cord and five people running after him. The problem is complicated by the fact that horses can arouse from anesthesia and move without a warning, including things like blinking, reflexes, and other usual indicators of arousal from anesthesia.
I move out of his way (I was in the worst position) and shout to the two guys helping me, "Get him DOWN!!!!" The owner tackles his head and wrestles it to the ground like a bulldogger at a rodeo. The other guys is ready to do the same and the horse than rolls up and sits sternal. Oops. "GET HIM DOWN!" I shout. They then both tackle his head and shoulder and roll him on his side. He starts kicking and flailing his feet as I go behind him and grope between his back legs for the emasculators. Still there, thank God, but did they stay where they were supposed to??? I squeeze desperately as his feet come perilously close to my head. The owner's wife comes out, "Can I do anything to help?"
"Yeah," I reply, "go to my truck and get the black tackle box and the yellow tackle box." I'm telling her to get my drug box and my syringe box. She races back with the requested boxes. Now what, though? I am holding the emasculators and my helpers are sitting on the horses head and neck. How am I to inject this horse??? I look down at my watch. Thankfully, 5 minutes have passed and I can let go of the emasculators. I gingerly removed them, drawing them out of the incision where the creamstor muscle had pulled them, and race to the drug box.
I quickly draw up a half dose of my original induction drugs and slip between my helpers to give the drugs in the jugular vein. His kicking and flailing gradually diminish. I rush around and look at my surgery site. Minimal bleeding is a good sign, but the true test will come when he stands up. Did the emasculators stay on? If he bleeds excessively, I will have to re-anesthetize him and search blindly for the end of the cord. Then I'd have to tie it off.
The horse sleeps peacefully for another 10 min. When I judge the time is right, I take the towel off his head. He blinks for a few seconds, than smoothly rolls sternal and gets up. I peer frantically underneath him. A few drops of blood and some clots greet me, but no gush of blood do I see. I stand back and thank God that I don't have to do anything else to him.
The horse stands there, looks around at me, than calmly puts his head down and starts eating grass.
Thank You, Lord, for sticky emasculators.
Friday, October 3, 2008
I unblocked a male cat. He won't get up to temperature (this AM he wouldn't even read on the thermometer) despite warming devices. On IV fluids. His BUN when he came in was over 200. It was ">140" today according to my stubborn machine. I don't think he's going to make it. He may actually have pyelonephritis- I can't tell for sure without an ultrasound, but that's what his blood work/urine make me think.
Had a German Shepard Dog (they make us put the "dog" behind the name) puppy with carpal laxity and Achilles laxity walking palmograde and plantigrade. Hope it will strengthen, but may not- may even turn out to be myesthenia.
Tomorrow I get to geld a 4 yr old "small" Clydesdale horse. He's small for a clyde anyway. He still weighs over 1500 pounds. Hope I'm still with the land of the living tomorrow afternoon....
Wednesday, September 24, 2008
Some cats, be it because they are old, or obese, or old and obese, can't get the 'ole pluming movin'. When that happens, they quit eating and some, being cats, develop hepatic lipidosis when their body tries to metabolize fat for energy and konks out. So, we as professionals who have survived four years of rigorous schooling and learnin' have to do what anybody would do.
We have to give cats enemas.
Now, I have only been at my current job about six months. In that time, I have probably had 4-6 cats present with this problem, and at 1-5 enemas per cat, have given way too many cat enemas in six months.
Cats aren't too appreciative when you shove a long red rubber catheter up their rectum and pump 60-120 mLs of liquid up there. Some react in an adverse fashion to this torment. Visions of buzz saws with legs come forcefully to mind.
My current candidate weighs 26 pounds. He has probably 5 pounds of poo sitting in his colon. That's a lot of poo. And I gotta get it all out. If enemas don't work, we go to sedation and manually de-impaction. Yummy!
No matter how many pairs of gloves you are wearing, cat poo can penetrate and make your hands smell soooooo good for several days!!!
Friday, September 19, 2008
I'd been gone for two days doing various things, and came back yesterday. First thing in the morning my receptionist hands me a chart and says, "The lady on the phone's dog has been having seizures all morning." There's nothing like the mention of seizures, either cluster or status, that is guaranteed to send me shuddering. Then, right as the seizing dog comes in, another weak dog comes in with what tunes out to be an abdominal tumor. A huge abdominal tumor. A huge, bleeding abdominal tumor. Also, I have a cat in the hospital with a protein loosing enteropathy who was chewing his IV catheter out. And all the other routine vaccines, ears, and other things I saw. And that was just before 11 am!
So, we got the seizing dog stopped. Luckily he'd only been having cluster seizures for about two hours and hadn't yet gotten an elevated temperature or lactic acidosis. He got diazapam, we loaded him on IV phenobarb and he went home ok. Stoned, but ok.
Same could not be said of my tumor dog. Sadly, he had myriad of other metabolic disorders along with his bleeding abdominal tumor and his owner elected to euthanize him. Frankly, I think that was a good choice since he was a poor anesthetic risk and those spleen tumors have a very high rate of metastasis and a low survival rate after removal.
My cat loosing protein looked really good after he chewed his catheter out, and I started him on some new meds. We'll see how he looks tomorrow.
Tomorrow should be pretty ok- I get to spay an alien! A dog named Alien, that is!
Monday, September 15, 2008
However, this time of year is when business really slows down for vets. The farmers go into the field and don't have time to bring the dog in for shots. People want to spend time outdoors and don't take the dog in for shots.
I don't like spending hours doing sudoku at work.
Also, we had the remnants of Hurricane Ike go thru and dump 6 inches of rain in one day. All the rivers are flooded. Yuck.
I hospitalized a cat today. IV fluids are going, medicine has been administered. I don't really know what is wrong with the cat. He's been lethargic and not eating or drinking for a couple of days. He is dehydrated. Blood work showed a white count of 31,000 (very high) but all segs, no bands. Is this cat just stressed out with a stress leukogram? Or does he have an infection? His glucose on original blood work was 334, but this is stress range for a cat and a repeat was only 160. We'll see if he improves in the next few days on fluids and antibiotics (just in case). I know, we're not supposed to use antibiotics without a clear cut infection, but I can't not use them with a white count that high. Screaming can commence. We'll see in a few days!
Thursday, September 11, 2008
... you can talk about blood and pus while eating a sandwich or bowl of soup.
... you really don't notice or small that odd smell inside your work truck (that one's for you Techgirl! :)
... pus is cool.
... you read magazines with pictures that would curl a layperson's toes.
... you're excited to go to CE and learn about the latest advances in feline lower urinary tract disorder.
I could go for a while more but I have to leave now and see more allergies. See previous post.
Thursday, September 4, 2008
Lately, my day has gone something like this:
Vaccinations AND Allergies
And on and on and on and... you get the picture.
Vaccinations are an important part of a well pet program. Allergies occur on a large basis.
But that's been ALL I've seen lately. I may as well record my allergy talk and play it when the clients walk into the door. It would do about as much good.
I'll be back when something cool, funny, obnoxious, or gross happens.
Wednesday, August 27, 2008
Monday, August 25, 2008
So, our goal was to reconstruct this shelf of tissue between the rectum and vaginal vault. This involves long hours spend with long handled tools. And I mean LOOONNNNGGG handled tools. I'd never seen a scalpel handle 18 inches long before!
Remember that this procedure is literally right up the rear end of a horse. We had put a cotton "tampon" up her rectum to keep her from pooping on our parade. But remember, in horses the urethral opening is inside the vaginal vault. I'll never forget the sight of our equine surgeon standing with 18 inch instruments with his face 2 inches from the rear end of a horse and his mouth open in concentration. He was standing right like that when the mare urinated. On his face. With his mouth open. Twice.
That was such a good day.
So, I was on my preceptorship with my mentor, SuperGirlVet (Super for short) when we go to a farm with a few Hereford cows. A few moments to comment on Super. Super was a great mentor, very smart and intelligent, and I learned a lot from her. She has one interesting habit/trait that I always kinda thought was strange for somebody who spends half her life around cattle: she is a neat freak. Not in a bad way, but her truck and all her tools/toolboxes always had to be clean and neat. Her person as well, which is important later. She carried three or four complete changes of clothes in her truck.
So, we went on this call to see a Hereford steer that had not been defecating or eating for several days. We walk up to his pen and, being the insightful veterinarians we are, immediately see his problem: he has a prolapsed rectum. This is actually a pretty common problem in Hereford steers. The only real treatment for one that has gone for several days like this one is to amputate the dried up prune of his rectum that was sticking out and connect the two ends. Yuck, huh? So, we sedate him a little, give him an epidural, and stick a 60 mL syringe plastic cover into the rectum to provide a needle stoping point. The goal was to suture the two layers of the rectum together and then cut off the dead part, creating an anastamosis between the two pieces (sorry, I can't get much more technical without pictures and don't feel like searching for them right now). So Super starts suturing. I, the ever helpful student, am outside the chute cutting her suture and opening suture packs as needed. About this time the steer starts to wake up a bit and decides he doesn't like the syringe case up his rectum. Apparently our epidural hadn't taken so good...
He gives a gigantic push and a stream of blood and diarrhea (yes, that had been up a cows butt for two days) erupts all over the front of Super. She just stood there while dripping liquid off her chin and front. The look on her face was priceless! But, the show must go on! So she puts the syringe case back in and starts to put in the last few sutures. And there he goes again!!! Keep in mind, he hasn't been able to poop for about two days and had a lot to make up for! She puts in the last few sutures, cuts off the diseased part and pushes the whole mess back in. All the while dripping blood and cow diarrhea off various body parts.
Needless to say, I drove back to the clinic while she sat on a bunch of towels. Then she got a shower. Actually, three showers.
I laughed a lot and she just glared. Reminds me of another time....
Friday, August 22, 2008
My horse's eye looked 100% improved by 36 hours later. I re-stained it and found more very superficial ulcers, but the deeper one I'd been trying to heal was almost gone!! It looked sooooooo good. So, a happy ending.
Sorry about the lack of posts lately, been really busy but not much interesting has come in. I'll have to pull from my store of saved in my head stories.
Monday, August 18, 2008
So I've been treating a horse for a superficial corneal ulcer for over a month now. Corneal ulcers don't happen all that often in horses, and thank goodness, because they are a pain in the butt when they do. Not because they are hard to heal. On the contrary, they heal wonderfully on their own. However, you have to treat with broad spectrum antibiotics and anti fungals when they occur because of a horse's propensity to stick it's head into places filled with fungus and bacteria.
So, I've been treating this mare for over a month. This ulcer just won't heal all the way. It's almost healed, but not quite. So, I decide to do a procedure called a grid keratectomy on it, where you scour across the ulcer and the cornea with a needle to create a fresh bed of injury to stimulate healing. I also decided to use some iodine to chemically debride the ulcer site. So, in I squirt iodine. Instant disaster.
It was 7% tincture of iodine instead of a nice 1% solution like it should be.
So, no said horse has very swollen eyelids and conjunctiva and a cornea missing the top layer of epithelium. And we're having to put eye meds in every two hours. It's a good thing these clients like me. I still may get sued over it, though.
Hopefully the cornea doesn't decide to turn into a melting ulcer. Then we win a visit to Big Teaching Hospital down the road.
That thunking sound you hear? It's me hitting myself over the head with a 2 x 4. Thunk. Thunk. Thunk.
Thursday, August 14, 2008
Me: Well, you know, Foo Foo should really be on heartworm prevention all year round...
DumbClient: Why? I've never had any of my umpteen million farm dogs on heartworm prevention before? Why should I start now?
Me: You've probably had dogs die unexpectedly on you right? Well, them having heartworm may be a possible explanation.
DC: I ain't ever seen no worms in their poop.
Me: Heartworms live in the heart (hence their name, HEARTworms). They don't come out in feces.
DC: Well, my dog ain't ever outside, and isn't around any other dogs, so they can't get worms. (Yeah, and in the next breath they ask me if fleas are contagious)
Me: Heartworms are carried and spread by mosquitoes, so they don't have to be around any other dogs to get them. And even the most well trained dog has to go outside with the mosquitoes to potty sometime. Also, mosquitoes can get in the house!
DC: Well, I ain't ever done it before and I don't see a reason now... ok, how much does it cost?
So we talk about cost some. Then, just when I get the battle almost won...
DC: Ok, I don't really see the need, but go ahead.
Me: Well, before we put them on prevention we need to test them to see if they already have heartworm.
DC: What, how much is that going to cost me?!? I only brought $0.14 with me and I don't have a credit card, a checking account, savings account, or a piggy bank. I can't be spending all this money on a darn dog!
Me: Well, then how were you going to pay for your vaccines????
Ad nauseum. The only thing worse than the heartworm talk is the spay/neuter talk or the Lyme's disease vaccine talk. Though, oddly enough, more people will go for the Lyme's vacc.
I should just tape this and record it when clients walk through the door. I probably have this conversation about 50 times a week.
Course while we're talking about client stereotypes...
Nahh. That's for tomorrow. :)
Wednesday, August 13, 2008
As in, rushing to pet and reassure that animal.
Because then you get bit. A lot. As in three times in the last four months, two of which needed an ER visit. That's three more times than I've been bit in the last six years. I've NEVER (knock on wood) had to go to the ER for a bite. Only once has something gotten me and even broken skin.
Now, I admit, since moving out of the technical field into the doctor field, I am usually the do-er, not the holder. In my opinion, the holder is much more at risk than the do-er to get nailed. In addition, my reflexes are honed to a fine edge.
Also, cats have five sets of weapons, dogs only one. You control a dog's head, you have the dog. A cat is a little more complicated.
And a muzzle is our friend. Both with cats and dogs, although the previous caveat applies to cats. Towels and leashes are also appropriate, as well as the rabies pole on occasion. And chemical restraint/sedation. Better living through modern chemistry.
Don't just try to pet any old strange dog. Watch for your visual cues. And don't get bit.
Monday, August 11, 2008
I can do sooooo much better than that.
Parvo poo (picture GI bleed on steroids) with tapeworms and roundworms that are MOVING. Tapeworms look like little grains of white rice and roundworms look like spaghetti.
Get THAT picture out of your head folks!
Signed, your friendly neighborhood gross-out-your-readers specialist.
Sidenote- I can't spell spaghetti. Gotta love spellchecker.
Saturday, August 9, 2008
Thursday, August 7, 2008
I have two of those that I just love to do. One is castrations. Now, I'm not a feminist nut thinking everything must be castrated (however, just why does your dog need his testicles, anyway?) but I do immensely enjoy the procedure. Mainly because of this gratifying POP feeling/sound as you squeeze the testicle out of your incision and free it from the surrounding fascia. It is soooooo fun. Lots of people look at me weird when I say that, but it's kinda like popping a zit, or squeezing a grape out of it's skin.
Another procedure I really like is shaving maggots. Not because I enjoy maggots, but because it gives me a nice glow inside to finish and then see an area that was nasty and dirty and full of the little suckers and see a clean wound with no wriggly things in it.
Another is lancing abscesses. I think we all like those. I like doing aural hematomas, too. Those really like to fly!!! Course, all of the above except for the castration are procedures you definitely want to keep your mouth closed while doing.
My assistant found that out the hard way the other day.
Wednesday, August 6, 2008
A Bad Vein Day Dum dum duuuummmmmmm... (play evil sounding music here)
So, I was trying to draw blood for a heartworm test. No big deal. Tuberculin syringe, a little bitty 25 gauge needle. A big hosepipe vein that I can SEE popping up at me. So I poke. The dog moves. So I poke. The dog moves. I poke again... the dog doesn't move this time. But no flash in the syringe. No satisfying gush as the syringe is filled with the pitifully small 0.2 mL of blood I need for this test. So I move the needle around a little more. And a little more. And a little more. Try the other arm. Move around a little, move around a lot, that's what it's all about... Oops, wrong song...
So, four of those later, I am faced with a sick cat. The cat seriously needs some IV fluids, IV antibiotics, IV everything. And an emergency surgery. Cat has a fever of 104.5F, about 10% dehydrated. The whole nine yards. So, we prep for an IV catheter (Terminology difference: we call them IV catheters, most of the human medicine types I tell this too think urinary catheter. No, it's an IV). Anyway, stick this teeny dehydrated vein with a 22 gauge, get a flash (hallaueigh!), feed the catheter- vein blows. I try the other arm and can't even get a flash. Go figure. We end up doing subQ fluids just to get her going. and SQ antibiotics. Not as good, but something at least. Later my boss gets one in with a cut down.
The next day I hit every stick I tried first time. Even the tiny furball who weighed 3 pounds.
Try getting blood out of a ferret. That is challenging.
Tuesday, August 5, 2008
I got bit the other day. Now, getting bit is part of my occupational hazard. Bit, scratched, kicked... This is well known in my profession, and we tend to regard getting bit as an EMT may regard getting yelled at, or an ER professional may regard getting bled on. There are few diseases I can get from my patients by saliva, with rabies being the biggie. With the result that I am the only person in my family that can say I've had my rabies shot(s). Gee, hear my tags ring? Anyway, I got bit the other day. I have a huge bruise on my arm with some paired teeth marks. You may ask, was it a mean dog? A cat? A horse? No, I haven't been bit by a cat, dog, or horse in a while. This was the mean bunny rabbit. And it wasn't at work, it was at home, where I raise rabbits. However, the result of this bite? I spent all day at work explaining to clients that no, a big, mean dog did not eat me, but a cute, fluffy bunny wabbit. Go figure.
Monday, August 4, 2008
Not much going on this last week. We're getting ready to synchronize a group of cows to receive embryo transplants. It's a cool process, and it's amazing to me that we can freeze and thaw out not only seman, but embryos as well. I also saw some alpacas last week in addition to my normal dog, cat, and horse patients. And got spit on for my troubles. Nothing stinks like llama and alpaca spit. Go figure. For once, I'd like something in my profession to small NICE. Wouldn't that be a great feat? "Wow, ma'am, Fluffy's diarrhea smells just like fresh lemons!" Yeah, not going to happen EVER. Oh well, I digress...
More to come! Keep the comments coming! I like comments!
Saturday, July 26, 2008
Friday, July 25, 2008
I've given a total of 2.5L of SQ fluids...
Probably 6 mLs of Cerenia (new anti-nausea drug)...
About 4 mLs of Convenia (new long-acting antibiotic)...
About 3 scripts of ciprofloxacin or enrofloxacin...
And sent 5 virus spewing, contagious, going to infect their whole neighborhood in spite of the long talk I gave them dogs home.
And this is on top of the possible distemper dog! That sorta looks like parvo.
I feel like I'm swimming in diarrhea. The floors of the place have been bleached about three times a day for the last three days.
I go home and dream of the smell of bleach and vomiting dogs...
I need a life! I hate Parvo!!!!
Wednesday, July 23, 2008
So, I see a puppy earlier. No vaccines (owners were told that they didn't need any- how gullible can you get?), vomiting, diarrhea, anorexic and lethargic. STRONG positive on the parvo test, the positive dot came up before the control dot. And we're surprised....???
Then I see another puppy. Same signalment, no vaccines, but this one also has a nasal discharge and some eye goupies. Temperature. So, I do a CBC on this tone. We have a neutrophillic leukophillia with a severe lymphopenia. Can we say distemper? We hardly ever see distemper nowadays-because-we-have-such-wonderful-vaccines.
The parvo puppy will probably survive. The distemper one probably will not.
Please, whatever you do, VACCINATE YOUR STINKING' DOG!!!!!!!!!!! Then I won't have to see completely preventable viral diseases.
Monday, July 21, 2008
I'm sure the horse was appropriately thankful.
Friday, July 18, 2008
However, similar changes in mentality are even more pronounced in some lay people I see. Most people, if their loved one wound up at the doctor's office or emergency room, are only thinking about saving that loved one. No expense is to be spared, no procedure too exotic. But, when their loved pet winds up in the vet's office, a whole new set of rules suddenly apply.
There are several variations on this theme. Some come out in the preventative medicine that they get for their pet. "Just what the county requires" is a common quote we hear when people bring their pet in for vaccines and we offer them the FOUR recommended yearly/tri-yearly vaccines their pet probably really needs. However, only Rabies is a law and is the only the one the county will nail them on if it's found out they don't have one. Other variations are less tangible.
If a 15 year old small breed dog comes in an acute renal failure on top of already being in chronic renal failure and the owners can't afford/don't want to pay for hospitalization and fluid dialysis...
Or a hit-by-car (HBC) dog that has several broken bones and needs an orthopedic surgeon...
Or somebody who drives up in a Hummer with large rocks on their fingers who wants to euthanize their pet because it's urinating on the carpet...
All these pose moral, ethical and legal delimas that are not found in human medicine. Since our clients are required to pay for services themselves without insurance it is hard sometimes. Hard to refuse to treat a sick pet because the owner can't pay and we have to afford eat, ourselves. Hard to see a sick pet get euthanized because the owner "doesn't want to put them through" a treatment that would save their life. Hard to watch a pet that has been sick for a while while their owner tried everything possible to save their life...
So what is the better way? We don't usually have cancer victims that are kept alive only by ventilator, or nursing home patients whose relatives "can't stand to loose" them as they get shipped to the ER over and over and over. Vet med has that which can be the greatest of gifts- a final, dignified and painless end. However, it can also be an "out" that, instead of a last kind resort is the way of the lazy or careless. So what is right? Is any of it? Or perhaps, all?
Maybe like many things, there is "no one, true way" but many ways, all equally valid or invalid?
Maybe I need to quit posting after a bad morning.
Friday, July 11, 2008
|What American accent do you have? |
Your Result: The Midland
"You have a Midland accent" is just another way of saying "you don't have an accent." You probably are from the Midland (Pennsylvania, southern Ohio, southern Indiana, southern Illinois, and Missouri) but then for all we know you could be from Florida or Charleston or one of those big southern cities like Atlanta or Dallas. You have a good voice for TV and radio.
|The Inland North|
|What American accent do you have?|
Quiz Created on GoToQuiz
Thursday, July 10, 2008
Horses are fly magnets. Flys like to land on a horse's legs and body, causing the horse to, understandably, try to get rid of them. They will flick their skin, stamp their legs, try to rub their legs, flick their tail and generally try all options to get rid of the flies that have landed on them. However, when trying to suture a baseball sized wound on the shoulder of a horse while it's sedated VERY heavily to try to keep him from stomping, flicking his skin, and otherwise trying to shake off the annoying "fly" that is me and my suture needle they can be annoying. Especially when said horse that is HEAVILY sedated to keep him from doing this decides to walk foreword and FALL on said vet trying valiantly to suture his shoulder wound. Lucky he only weighted 800 pounds (he was a weanling). Lucky he only caught the edge of me. I wish I had been lucky enough that the owners would have had fly spray.
Wednesday, July 9, 2008
So, I'm oiling a horse. Oiling a horse, often done during colic, involves passing a NG tube (often while the horse is sedated or twitched) and pumping a gallon of mineral oil down into his stomach, being VERY careful to NOT pass the tube into the lungs. You'd be surprised at the particularly nasty aspiration pneumonia mineral oil can create. Anyway, I had just finished this operation, it was late at night, and I had just unhooked the NG tube from the pump I had used to pump the mineral oil. I was holding it up getting ready to kink it off to pull it when the horse sneezed. This put pressure on his esophagus and propelled mineral oil mixed with water (that was in the tube) into the air and down on my unsuspecting head. Needless to say, a shower was taken upon arrival home.
Monday, July 7, 2008
... a pediatrician
... a family practitioner
... an emergency room doctor
... a social worker
... an end of life specialist
... a hospitilist
... a dermatologist
... an internist
... an anesthesiologist
... a surgeon
... a pharmacist
... an immunologist
... a lab technician
... a contagious disease specialist
... and a phlebotomist
ALL IN ONE DAY and in some cases all at once!
And that was just this morning....
Saturday, July 5, 2008
There are some aspects to July 4th that "ordinary" people do not think about, however.
Tangent: I go on lots of tangents, or Rabbit Trails (RTs), a legacy of vet school and procrastinating while studying. I submit that veterinarians are not "ordinary" by any sense of the word. I will present more evidence towards this later, but here is the first piece. 1) Crazy people go to vet school. The truly insane stay all 4 years.
Anyway, things ordinary people don't think about the Fourth. 1) Fluffy/Fido probably would love to smell that burning thingie on the ground. Please keep them from doing this as it is a detriment to a long and happy life. 2) Dogs can get so worked up they send themselves into heat stroke from anxiety. I'm not kidding. 3) Sparklers are NOT good to eat. 4) Bottle rockets are even less good to eat. 5) Activated charcoal does not like to come out of scrub tops and pants. 6) A dog who doesn't feel bad and doesn't know better likes to chew out his IV catheter.
Cats and fireworks are kinda iffy as well. Some cats use their God-granted right to complete indifference to nobly ignore the noise as usual. Others get so stressed out they go into respiratory distress. Have you ever tried to give oxygen to something trying to claw your eyes out?
So that's my primer on the Fourth of July, veterinary style. Good day.
Monday, June 30, 2008
This month I have seen three cases of brain tumors. Brain tumors. I haven't seen ONE case in over a year, and this month I see three. Two cats and a dog.
The stinky part is that in animals, not many owners are willing to spend the thousands of dollars necessary for specialized treatment in a referal institution with a poor prognosis for long term survival. Chemo can be done to some extent, but an MRI for an animal is a big deal, requiring general anesthesia (I wish you could tell animals to HOLD STILL, but that is a different post...).
Three. Brain. Tumors.
Friday, June 27, 2008
1) People that come in as walkins during a busy day.
2) People that come in as walkins during a busy day.
3) Somebody comes in and says, "Doc, my dog has been loosing weight for three months, vomiting for two months, not eating for a month, oh and by the way, can you give him his Rabies shot and trim his nails while you're at it? And how much is this going to cost me?"
4) When the aforementioned person who asks about cost says they only have $20 on them.
5) "My horse has had a tummy ache for 5 days" at 5 PM on a Friday night...
I can go on for hours, but you'all will get tired of reading!