Friday, December 25, 2009

White Christmas (and then some!)

I love snow! Particularly if you can get out in it and just play without worrying about needing to be somewhere. Under those circumstances, multiple feet of snow would be perfectly fine with me.

We got some wonderful snow. I can't quote figures for you but apparently it set some record in the little town where I currently abide with blizzard conditions for the first time in years. I was up until 2 a.m. on Christmas Eve just enjoying watching (and playing in) the snow. The wind was crazy and swept clean certain areas while creating enormous drifts in others. There was a lovely drift about 3.5 feet high in front of my door (the one I don't use) and it proved great fun to jump in it then make a snow angel. My four-footed, furry children were mortified at mom's behavior. As they are either a) older or b) very cold natured they chose to lie on the couch and ignore me. If the big dogs were with me rather than at home with my mom at the moment, I'm sure they would have joined in the fun!

Final result was that we had an absolutely beautiful white Christmas. I'm on ER duty. On day duty 24-25 then from 8 a.m. today (26) until 5 p.m. Sunday 27. That's the only fly in the ointment for this lovely event.

On Christmas morning, I was told that they would scrape the road shortly so I called, told the other intern to leave the ER phone and have them call me directly if something came in before I got there. Yeah, that didn't work out so well. I got a call around 9:30 a.m. and they still (8:30 a.m. 26) haven't scraped the road. At my place, the backyard is almost bare just outside the door, there are huge drifts along the side of the house, the drive is bare of snow being just a sheet of ice, and the road in front, well, what road? The drifts completely obliterated the area of the road extending in front of my house and the only way you know it's there is by the mailboxes. (The picture above actually contains two roads, I defy you to find them without the aid of vehicles or mailboxes!) I couldn't even get out of the drive. Had to hitch a ride in with a neighbor who has 4 wheel drive then hitch a ride home with the other intern. The worst part was that what I had to go in for was a Christmas morning euthanasia.

Don't let that comment make you believe I thought it was wrong. It was definitely best for the dog who had lymphoma and the nodes had gotten so big that she couldn't breathe. It's just so sad anytime but most especially at Christmas!

Fortunately today the snow is packed enough and some of the roads are clear enough to allow me to drive myself in to work. That's good because I need to be able to go home and finish packing which I intended to do last night but did not. And yes, I still plan to head out Sunday night unless it poses a risk for the critters. Hopefully, the roads will continue to improve and not be problematic. The interstates are supposed to be clear as of today but I have about a 60-70 mile jaunt on a small state highway to get there...

Thursday, December 24, 2009

Nothing will stop me!

Yeah, just so y'all know, "Neither rain nor sleet nor snow" nor flood nor poor road conditions nor fear/threat of death, etc., so forth and so on, ad nauseam, ad infinitum, are gonna stop my leaving on Sunday evening for my vacation time followed by my much anticipated out rotation. Unless there's a really good reason, I'm hitting the door as close to 5 p.m. as possible, tossing the kids in the truck, and heading out (I've almost finished packing already!)!!!

Merry Christmas, all. Have a safe and happy holiday.

Monday, December 21, 2009

Follow-up "October's Bright Blue Weather"

Helen Hunt Jackson (1830-1885)

October's Bright Blue Weather

O SUNS and skies and clouds of June,
And flowers of June together,
Ye cannot rival for one hour
October's bright blue weather;

When loud the bumble-bee makes haste,
Belated, thriftless vagrant,
And Golden-Rod is dying fast,
And lanes with grapes are fragrant;

When Gentians roll their fringes tight
To save them for the morning,
And chestnuts fall from satin burrs
Without a sound of warning;

When on the ground red apples lie
In piles like jewels shining,
And redder still on old stone walls
Are leaves of woodbine twining;

When all the lovely wayside things
Their white-winged seeds are sowing,
And in the fields, still green and fair,
Late aftermaths are growing;

When springs run low, and on the brooks,
In idle golden freighting,
Bright leaves sink noiseless in the hush
Of woods, for winter waiting;

When comrades seek sweet country haunts,
By twos and twos together,
And count like misers, hour by hour,
October's bright blue weather.

O suns and skies and flowers of June,
Count all your boasts together,
Love loveth best of all the year
October's bright blue weather.

Ran across this and thought you might all enjoy reading the source.

Saturday, December 19, 2009

A Week of ZEW

Had an interesting and unexpected turn of events that caused me to spend a week of my four week elective rotation on the "ZEW" service. Z=Zoo, E=Exotics, W=Wildlife. I'm not highly interested in these critters, preferring horses, cats, and dogs instead, but find them fascinating all at the same time.

Were not exceptionally busy but had a couple of fun things to talk about. I drew blood for the first time ever from a snake. I was told it was luck of the draw (literally, pun intended) and sort of like hitting a cow tail vein. Got 0.4ml before the fountain stopped but no one else could get any either so I didn't feel too stupid! Did discover, however, that a 14 pound red boa can whip my butt at arm wrestling. Was helping to hold for someone else and he was totally beating me and I was using both arms!! Makes you learn a bit of respect especially for a hungry reptile!

Had two flamingos come in from a nearby zoo on different days. This story makes it necessary to take a quick tangential rabbit trail (not me, sarcasm intended) to give some more kudos to one of my old teachers. I'll never understand people and most especially specialists. Most of them get so hung up on their overinflated egos that they can't even admit they don't know something that they probably shouldn't know! I was so completely spoiled and thus ruined for all other specialists by one person who responded with "I don't know but why don't we look it up together" or "Here is where you can find that" or something along those lines to my endless questioning. So many just laugh and make fun of your questions which used to make me feel really dumb until I figured out that it meant they didn't know either and just didn't want to admit it. Does make you appreciate those really special super teachers that you are fortunate enough to know here and there (just not often enough!). Now, back to the story, I think you'll see the reason for the tangent without my pointing it out.

First flamingo had a tear of his lateral collateral ligament at the hock. Happened about 2.5 years ago and had been repaired, repair failed but the bird had made enough scar tissue to be doing well until something happened to re-injure the leg. Took to surgery and used two bone anchors like sometimes used to correct a cranial cruciate ligament rupture, tied the sutures together and basically recreated a ligament. The bone anchors were designed in an attempt to make the lateral suture surgery more successful by limiting areas of failure and easier. The basic premise is that a screw is placed in the distal femur rather than looping suture around the femorofabellar ligament then the suture that is already attached to this screw is pulled through the hole drilled in the tibial crest. Exact concept of lateral suture but a little different anchor. We placed one in the distal tibia and a second in the proximal tarsal bone then tied the suture in the middle. (I hope I'm getting the bones correct 'cause bird anatomy is a little confusing if you don't do it all the time!)

The second bird had bilateral angular limb deformities. We made small approaches on the lateral aspect of the proximal tarsal bone (same caveat!) in order to make an osteotomy (cut in the bone) allowing the bone to be positioned correctly. Then small ring external fixators were placed using K-wires for stabilization. Went really well and you could see an amazing difference in the clinical picture although the radiographs were less impressive. Way cool surgeries!

I'll now point out my complaint. I read extensively about both procedures the night prior to the surgeries and every single reference I pulled regarding surgery on a bird / flamingo's legs stated not to close the skin. As I understand it, their skin on their legs lacks the ability to stretch and expand like ours would (at least to an extent) therefore closure results in either tearing of the skin (dehiscence) or creating a tourniquet / compartment syndrome effect. The first bird did well except that the day after his foot was swollen and blue then the sutures tore and it resolved. Even after that, the second bird had both incisions closed. Apparently even a tiny amount of inflammation is enough to result in the tourniquet effect. I think somebody didn't read about birds... I also know somebody doesn't listen to those around because this was pointed out and ignored. I probably PO'd that somebody yet again. Oops. Maybe one day I'll learn to keep my mouth shut but I doubt it!

We also saw Andy, a kinkajou who belongs to a lady that has exotics and uses them for education. Andy broke out of his pen and got attacked by a dog several weeks ago and is now healing nicely. I did a rabbit dental, much like floating a horse's teeth but far less strenuous and I neutered a guinea pig. Usually, the ZEW service is pretty busy but we were a little slow this week due to the approaching holidays. This allowed time for me to exert my bad influence that somehow results in other people carrying out scathingly brilliant ideas that they would not normally even consider. (I don't know how I do it. Honestly, I don't even try; it just happens!) We got antlers and a red nose for one of the clinician's van, stole (er, I mean borrowed without permission) her keys, and decorated the van. We were planning to put battery powered Christmas lights and garland on another's motorcycle but he didn't drive it:( Pooey! Overall, a fun week which just goes to show that often the things that are unplanned are better than those that one plans in detail.

I'm on ER this and next weekend, cover the day ER shift on the 24-25, and am on anesthesia for the first few days of the week. I get vacation (HALLELUJAH) the week of New Year's and am heading home for some relaxation. The next week, and last of this rotation, I spend as an elective out-rotation at my alma mater. Will refrain from going into detail on this in order to protect the innocent... Then it's back to overnights but it's my next to last overnight rotation so I'm rather excited - I don't count the extra 4 nights that I have to do right at the end of the internship 'cause they'll be a breeze when I'm that close to done! Time is flying like mad and all too soon I must finish placing my ranks for residencies and then will find out if I matched or not. Probably won't have much time to write after this week and plan to drive out as soon as I am finished here on the 27th! With that, I wish everyone a very Merry Christmas and a Happy and SAFE New Year!!

Sunday, December 13, 2009

Teaching pains

Had a very interesting teaching experience last week that I thought was worth sharing. I'll start by reminding everyone that my primary interest lies in surgery - particularly soft tissue surgery.

Last week, I took two of my little foster kitties in for a spay. I was on community practice rotation which is one of the rotations that the students have the opportunity to do spays and neuters. The usual clinician who handles the surgeries was out for a meeting thus making it so that the students assigned to surgery had nothing to do. I asked if they were interested and offered the kittens if they wanted - they were very enthusiastic!

So, I took them in and taught some common sense medicine. They got worried because one of the little ones had a temperature of 104 and a glucose of 88. "Should we postpone the surgery," was the question I was asked. My comment caused a slight gasp because I said, kitten sounds great and has felt great at home, eating / drinking / playing, etc. but had been fasted for the night so I voted to move forward.

As I told both students, it was their surgery and I was only scrubbed in to give advice and help if needed. The first student did a good job. She knew the concepts well, asked good questions, and followed directions / suggestions as I gave them. She was closing the skin with an intradermal pattern when life got interesting. Anesthesia called in to ask if I would be angry if we aborted the surgery on the second kitten because there was going to be a short power outage. Told them no problem but there wouldn't be another opportunity because if not done that day I had planned to take them home with me on my vacation time and spay them at home.

They wavered back and forth then decided to go ahead with it. The second student really did not have good soft tissue handling skills. I felt that I should tie my hands to keep from taking things away from him and finishing myself. It was then that I realized that I think I may be developing an ego - something that I hate in others!

The first student had asked how easy it was to actually tear the blood vessels and the second provided a teaching opportunity on that point. In cats, you don't really have to break down the suspensory ligament in order to ligate the ovarian vessels (they tend to be very stretchy). I usually do just because that is one less thing to ligate thus (in theory) giving better ligation of the vessels. The student didn't want to and I had told him that was fine but that it should be ligated with the vessel. He made a window cranial and caudal to the vessels and was struggling with getting the suture around and I told him either break down the ligament or ligate it. He ignored me and kept struggling. To make it worse, we were working with a time crunch because the power was going out shortly. I stopped him and said I would break down the ligament, then took a gauze sponge and started to do so. He was impatient and grabbed an instrument then used it (sort of like the proverbial bull in the china shop) to try to break the ligament.

The result was that the vessels tore beneath the instrument but the ligament was still intact. Good news was the the vessels tore above the clamp but boy was I aggravated. In my most sarcastic tone (after clamping the bleeding ovary) I turned to the first student and said, "In reference to your earlier question regarding how easily the vessels can tear, you will note that the ligament is intact and the vessels torn." So maybe sarcasm was inappropriate but it kept me from shaking the other student and taking away his instruments. I then personally tore the pesky little ligament.

It was very difficult for me to continue watching and instructing as he ligated the uterine body and started closing. He then tore his glove about 1/4 of the way through closing the linea. This was my second nagging feeling of developing an ego because, as I continued suturing backwards (because not only was I on the opposite side but he is also left-handed) while he changed gloves, I thought, "Man, I suture faster and better backwards than he does forwards." I allowed him to place skin sutures because it would be faster than intradermal and we were still awaiting the power outage. The other frustration (as insinuated earlier) was that he did not listen well. I kept loosening his sutures because skin sutures are not supposed to be tight and he kept tightening them again. The funny part was that the power went out for all of 45 seconds in the rest of the hospital but not in the surgery suite where we were. I wish anesthesia had told me and I would have made him go back and do intradermal sutures.

Both kittens are doing well despite the challenge (and stress) for their foster mother. I'm not the most compliant client and they were playing like little fools the day after.

The other outcome of this experience was to make me even more grateful for the wonderful surgery clinician with whom I worked in school. I feel huge empathy for the stress that must have been felt as he watched us students learning to do such basic things as suturing. I would like to think that I was not as much of a stressor but even the little ego that grows won't allow me to believe it;) Now I must find a way to squash this ego before it gets out of hand since that is one of my biggest pet peeves about specialists in general!

Tuesday, December 8, 2009


I don't know exactly what it is that sets me off sometimes. At times it takes very little to get me started; others it takes a major blast. Right now, I 'm in full swing and having fun at it.

On Friday, I started a war (or, to be more precise, I helped to start a war). My role is ideas. I come up with really good ones and somehow goad other people into carrying them out. We confettied one of my intern-mates desk with little sheets of paper labeled with his name. There are literally millions of wonderful ideas floating around in my head as we speak of other things to do to him and others.

Yesterday, we pulled one wheel off his chair and dumped him in the floor. We were all in the office and he came in, pulled out the chair, sat down, did his work, then left; all without incident. None of the rest of us could figure out why. Then today, I walked in the office to find him looking guilty and moving the chair. He told me he got dumped and was switching it with the presumed perpetrator's chair. In the course of the conversation, he asked if I had done it to which I replied (with suitable sarcasm) "Me? I would never do something like that!" Totally went over his head that the translation for my comment was "No, not directly, but I knew about it and helped!!"

The greatest part is that I can randomly change sides in this war - and believe me I will!

No, I change my mind. The absolute greatest part is that nobody believes it of me. There is something to be said for keeping people at a slight distance so that they only know the part of you that you choose to let them know. Everyone here thinks I am innocent and sweet. They would never accuse me of doing things like changing the computer cables around to confuse desktops so you can't access your own stuff...

The only drawback to my war is that it is preoccupying me slightly because I keep coming up with wondrous, cantankerous ideas to carry out and it pulls me away from my cartoons. My loyal public will likely get mad but since they never bother to give feedback anyway, I shouldn't worry too much.

Not exactly sure what set me off on this at the moment. I was terribly depressed then suddenly became consumed with practical jokes starting with the phone during my presentation. Must admit I feel much better at the moment. I think that tomorrow, I'll take all of the wheels off of all of the chairs and see what happens...

I've seen some kinda cool cases lately and need to post them for the entertainment of all but haven't gotten around to it yet. Very talented when it comes to procrastinating:) I did get all of my match crap done and, as of right now, both of my friend's dogs are doing well. Let's hope that continues. It's definitely nice to be out of the middle of the cardiologist and the student she wants to maim but I'm still concerned about the situation and will likely do something stupid and get myself in trouble. Not like it would be the first time. With that shall close for now - must be there early in the a.m. since we are spaying my little foster kittens tomorrow.

Sunday, December 6, 2009

Eating Scrambled Eggs or At My Place

One of the known dangers of eating scrambled eggs is the eggshell. Despite extreme care, it is always possible that little fragments will wind up in the egg and not be fished out. This is one of my biggest pet peeves (it carries over to boiled or otherwise prepared eggs as well) and I am almost fanatical about making sure that no shell dared to spoil the meal. There is not much worse of a feeling (when eating) than biting down on that crunchy piece of shell.

It is rare that I have people over to my house but, on occasion, I do. I actually enjoy cooking and don't mind feeding folks, I'm just a bit of a hermit in general. I had a couple of people over last night and it came to my attention that eating at my house is very similar to eating scrambled eggs. Dangers lurk within the food, unwary eater beware!

I spent a lot of time making sure the place was clean in preparation for company, including wiping the kitchen counters down meticulously. I made pasta and you should imagine my chagrin at noticing two white cat hairs on the boiler as I drained the excess water. Yes, hair lurks at my home and I probably ingest it unknowingly on a daily basis. Who can help it with so many furry, four-legged children plus myself who is not deficient in that category. If they noticed the extra add-ins, they refrained from comment. Guess I'll know if I ever try to invite them back over...

Friday, December 4, 2009

Amusing myself...

Thought I would take a minute to give an update and tell a funny story. This week and the one prior have been two of the most stressful weeks I've had in quite some time. Between trying to finish match crap, working on revamping my article that I hope will be published, preparing a seminar presentation, dealing with a friend here who has a 12 year old Great Dane with multiple health problems that everyone else has given up on but she's not ready, hearing from another friend who recently lost one dog to acute renal failure and now found out that her other dog has lymphoma, and being the "maniac in the middle" on cardio where the cardiologist hates the student and wants to fail him and is only being nice to me to get me on her side, it's been a tad bit complicated / stressful / exhausting! [If you can figure out that run-on sentence;)]

Yesterday, I gave my presentation. And being a lover of practical jokes that do no harm, I planned a good one. Gotta tell the whole story though.

First, I hate public speaking. I'm rather shy and introverted naturally so I don't relish the limelight and usually have a difficult time saying good things about myself. The big day approached and I was rather amazed (and pleased) to find that I did not have a huge case of nerves. Everything was going good until I came to work and made a BIG mistake! I HATE elevators with a passion because I have issues with small, enclosed spaces. Yesterday, I was tired because I was at work late (came back to spend time with tech and her Dane when she called me hysterically in tears), I was carrying a very heavy bag of books, and I was having trouble breathing well 'cause I'm a little sniffly at the moment. Usually I park in the lower parking lot because I figure stairs are good for me since I get little enough time to exercise. This was no exception but I chose to take the elevator. BAD, BAD, BAD!! No, I didn't actually get trapped but, from my perception, it seemed as if the door took forever to open. I was actually hitting panic mode in which I was fighting the desire to start uselessly banging on the door and screaming for help. Needless to say, this shook my equilibrium just a little.

Second, I've noticed that the third year surgery resident (who I like a lot) seems to magically get an "emergency" phone call during seminars in which he is not particularly interested and ducks out early. I called him on it last week; he laughingly denied the charge. I told him a) I rather liked the idea and might implement it myself and b) if he walked out on mine I would know... Then I took my school issued phone and gave it to my intern mates with the instructions to call him in the middle. They did. Twice. He silenced it then sent a text asking who it was. They told him me. A very funny conversation ensued in which they were arguing over whether I was good enough at multi-tasking to text while presenting. While I sincerely doubt I'm that good, I must have some capability because I was distracted by the drama I had created, kept thinking about the elevator and being panicky, and managed to present without most people noticing. The only poor comment I got was that I read too much from my notes. That's disappointing to me because I knew the subject cold and only had the notes for a safety but needed them due to my elevator incident.

I don't think he figured out the whole joke but am pretty sure he knows I am the mastermind behind it although I can't be certain of that since most people underestimate me because of my quiet disposition.

The good news is that the seminar is now off my plate, today is my last day on cardio, and the match crap will be done no later than Monday (deadline). That gives me time to revamp my paper and submit it and will at least somewhat decrease my stress load. And (imagine the "Hallelujah Chorus" in your head at this point) I'M OFF THIS WEEKEND!!!!!!!!! Now what I'll do about my two friends and their beloved companions I don't know.

Tuesday, December 1, 2009

Spit in THAT eye

So this post is going to be slightly ironic for a lot of reasons. First, because Insane is really the eye guru- she LOVES eyes. I HATE eyes. I think they're creepy.

So last week I have an odd eye case. A young pomerianian mix dog that had acute onset of blepherospasm and conjunctivitis. I stained it and it was negative for corneal ulcers so I sent him home with some triple antibiotic eye ointment to see if we could get a response with that.

He came in about a week later and his eye was MUCH worse. He now had bupthalmos (enlarged eye), marked blephrospasm (painful eye) and worse drainage. So I told him he needed to go to Big Vet School An Hour Away if he wanted to save this dog's eye, because it was obvious without doing an IOP (intraocular pressure) that the dog had some kind of acute onset glaucoma. He agreed and made an appointment for two days from them. I sent him home with some pain medicine to help keep the dog comfortable.

A week later he calls and said that he didn't keep the appointment at BVSAHA because "the dog was getting better." However now he thinks the dog's eye ruptured. So we make an appointment the following day to enuculate the dogs eye (take it out).

I enuculeated the dog's eye the following day. This was the first one I've ever done, and it was quite interesting! Very bloody. But I sent the eye into the pathologist because I needed to know whether the dog had Blasto in the eye or not.

So the pathologist calls me today- the dog's glaucoma was caused by heartworm disease! (BTW, we had tested him for heartworm the same day and he was positive- we started treating him) Apparently it's rare and very cool. So the pathologist is going to publish the case and I get to be a minor author! Very exciting- especially when I just kind of stumbled on to this one...

I'll try to think of a funny story soon!