Interlude

I just thought I'd take this time when I don't have anything funny to post to do a little public service announcement.

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.

What I want to be when I grow up

You know, I should be...

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...

Poster child for Why to Spay Your Dog

This is a radiograph of what my friends are calling "The coolest pyo ever!" This is a lateral abdominal radiograph of a dog that had a pyometra, or pyo for short. A pyo is a uterine infection. A dog that has not been spayed and has gone through several heat cycles is predisposed, through repeated levels of high estrogen, to a condition called endometrial hyperplasia. This causes lots of exaggerated folds to develop in the uterine lining. This condition further predisposes a patient to pyometra.

A pyo is a life threatening emergency. The uterus builds up bacteria and white cells and junk until it, 1) threatens to rupture the uterus, especially if it's a "closed" pyo where the cervix is not open allowing fluid to drain, 2) the bacteria emerges into the bloodstream, and 3) makes the dog very sick. Common signs of pyo include vomiting, fever, lethargy, anorexia, and a vaginal discharge if it is an "open" pyo with the cervix open. Often it occurs two to four months after the last heat cycle. Treatment includes stabilization with shock rate fluids, antibiotics, and emergency surgery to remove both the source of infection and avoid a possible rupture of the uterus. Antibiotics to not penetrate well into the uterus of dogs and just putting the dog on antibiotics, however strong, DOES NOT WORK.

This was not my case, nor my radiograph. They both belong to Dr. May B. Insane, who posted a true and pithy comment on my Wild Rodeo post. She kindly sent this rad to me and let me tell the story.

This dog came into Dr. Insane's emergency room after NINE, count 'em, NINE days of symptoms, after a referring vet TOLD THE OWNERS IT WAS A PYO AND GAVE THEM ANTIBIOTICS. Sometimes the stupidity of my colleges astounds me. Needless to say, she was still not feeling well. Lucky for her it was an open pyo and had been draining.

The tubule structure filling the caudal and ventral abdomen is this dog's uterus. It was kind of a big dog, too. Needless to say, an emergency surgery was lots of fun with a uterus that big, and the dog is having an excellent recovery.

SPAY YOUR DOGS, IDIOTS !!!!!@#$%^&^%$#@#$%^&^%$#@!!!!

A wild rodeo

So, last weekend I castrated a horse. This horse was a "small" 4 yr old draft horse. He hadn't grown as large as the owners expected and wasn't really big enough to use as a stallion. Therefore, they decided to castrate him. A wise choice, since stallions do not make good pets and can be hard to handle.

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.

Strange week

I've had kind of a strange week this week. Some interesting cases, too. I just took a "thingie" off a cat's ear that I've been trying to heal for about two months. It looked and acted like granulation tissue. Today the owner got fed up with it and wanted it off. I took it off. It wasn't granulation tissue. It looked like a squamous cell tumor or some other neoplastic grossness on the impression smear I made of it. Yuck.

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....