Tuesday, May 24, 2011

Another One Bites The Dust

Once again, apologies for the doom and gloom. I had a great upbeat post planned about kittens but circumstances have interfered and I can't do it right now.

Several things to update and share. I'll try to make it chronological rather than in order of importance simply for the necessity of logical thought.

Friday was yet another day from Hades. I walked in to find a 1 year old MinPin flat out on the table. He had been dropped off for vomiting and bloody diarrhea. Immediately set to work on him, somehow got lucky and got a blood sample but couldn't get an IV catheter in therefore left my tech working on that while I ran the blood. To list the highlights, leukopenia (low white blood cells 3000), significant hemoconcentration (HCT of 70% - Yikes!!!), Azotemia (both kidney values elevated plus high phosphorus level of about 14), total protein greater than 8, and severe hypoglycemia (21!!). Dog was obviously severely dehydrated and in septic shock. Called the owner to verify they wanted to proceed with such a poor prognosis while administering glucose on the mucous membranes while tech still working on IV catheter. Owner wanted to try so I wound up doing a cut down (cut through the skin to gain direct IV access) and finally threaded a tiny IV catheter into the dog then started bolusing fluids and giving dextrose. This dog actually had a good outcome (I know, I'm being glass half empty but you'll understand later) since he held up his head by around 11 a.m. then was sitting up by 1 p.m. Told owner not out of woods but at least trying to respond. Owner kept demanding to know what caused; I got a little frustrated and told her there was no way I could prove initial cause beyond doubt, point was dealing with septic shock right now. I was told they had "nursed him since Wednesday giving Pedialyte that he kept spitting up...."

Next case that made me bonkers Friday was the stray dog that came in to have her skin checked. A truly wonderful owner who was a little down on luck having lost her job. Classic case of flea allergy dermatitis. I euthanized the dog. Not because of the flea allergies but because the first thing I noticed was that the dog's eyes were red. My exam revealed hyphema (blood in the anterior chamber) in both eyes, iris color change in both eyes, retinal detachment in the right eye, huge peripheral lymph nodes (all of them 4cm or larger and firm), harsh lung sounds, and a fever. With that combination of findings I was left with cancer, fungal infection, or tick borne infection as the top 3 differentials. The dog was also heartworm positive, incidentally. Given the cost of further diagnostics and treatment as well as the guarded prognosis for all of the above and the potential roller coaster ride, the owner opted to euthanize. She had found the dog 3 weeks prior; at least the dog had 3 weeks of having been loved.

Then is the prodigal. Friday, my dearest brother decided it would be a great idea to take off home (about 425 miles away) by hitchhiking. He's still not well although doing some better with the presence of food, sleep, and lacking drugs. He finally let us know that he made it late Sunday afternoon. I'm glad he's safe but now I'm worrying about what trouble he'll be in before long plus he had all of us worrying while he was impossible to reach and hitchhiking. If he would only cooperate long enough to get everything out of his system he might actually rehab.

Lastly is my cat. In my experience, when dealing with a true "old cat vestibular" patient (meaning idiopathic vestibular), they tend to improve fairly quickly as in 3-7 days. Even ear disease as the underlying cause usually responds that quickly. I know that technically, the texts say 2 or more weeks but that also includes the nasty causes and has not been my personal (anecdotal) experience. Here's another acronym for y'all - FIP. Feline Infectious Peritonitis. A truly nasty viral disease for which we cannot vaccinate and cannot treat effectively. The diagnosis equals doom / death.

My Crazy Gracie most likely had FIP. She showed slow improvement over the course of 6 days and I actually thought she was turning a corner Saturday when she took a few steps on her own. Then Sunday, she seemed a little worse and couldn't seem to pass the hard fecal material in her colon. I took her to the clinic and gave her an enema and continued to monitor / treat her at home. Around midnight, she began to cry and when I got her out to examine, her mucous membranes were white, her abdomen was distended with fluid and painful, and there was no urine since several hours prior. Rushed to the clinic, bloodwork showed severe anemia, azotemia, and elevated liver values. Radiographs showed free fluid in the abdomen (surprise, surprise), small bladder, nothing else significant and an abdominal tap showed straw colored fluid. Granted, I can't totally prove it and have to say presumptive FIP but it fits too well and I couldn't justify putting her through more to prove it. She was hurting and probably trying to quit anyway so I euthanized her. I thought about trying to do a transfusion and treat her but...it just didn't seem fair to her.

I don't think most of my friends understand how deeply I feel these losses. They mostly seem to think that since I have so many in my herd it's not the same as when someone only has one or two pets. They are like my kids, though. Each one is special and loved, just like a person that has several children - you love them differently but it doesn't mean you do not love them equally. Now I'm wondering about #3. It seems that all things happen in 3's so do I count Stormy from last October, Ellie, and Gracie or do I need to hold my breath for the next strike. There are certainly enough geriatrics in my herd to wonder.

With that, I'll close. Figured I would update everyone this way since I'm not really in an appropriate state to talk to anyone. Maybe I'll manage my great kitten post sometime soon if life will cut me a break long enough to catch my breath and somewhat recover!

Monday, May 16, 2011

Soaps anyone?

Somebody help me!! I'm stuck in a soap opera and I can't get out!!!!!!!!!

Sunday, May 15, 2011

The Saga Continues

So much for my good intentions of an upbeat post. It would seem those aspirations are doomed for now. Last night, my dear old Uncle A-hole who is married to my Aunt Sweetie Pie and are the folks with whom the prodigal is currently staying, decided it would be great to try to start a fight with the prodigal because he was not ready for bed when Uncle A-hole was... Actually tried to take a swing at him. Fortunately my mom was able to intervene and stop it before it started which is really good because otherwise I don't know where the prodigal would stay. We haven't the extra room nor does anyone else in the family even if they would be willing and a motel is kinda scary given his current state and that there would be no one to watch over him. And believe me, he needs not only watching but to be looked after*!!

Additionally, one of my cats, Crazy Gracie, suddenly is unable to walk. I think (and hope!) that it is only vestibular disease but am not sure yet. Yet one more thing on the plate to worry about...

And I forgot to comment last night that my friend's dog with the presumptive insulinoma that I removed 10 days ago was doing great until day 9 at which time she suddenly became hypoglycemic again with associated clinical signs (shaking, etc.). Right now, I'm very done!!

*This is a reference to an older movie that most folks will probably not recognize since it's rather obscure. The movie is The Villain starring Kirk Douglas, Ann-Margret, and a very young Arnold Schwarzenegger. If you have the opportunity and enjoy slapstick on occasion, watch the movie then my comment will be appreciated on so many more levels than just the obvious one.

Saturday, May 14, 2011


Thanks to the Homeless Parrot for inspiration to post. I haven't had much time to read the other blogs that I usually try to keep up with at least somewhat lately but then discovered that my mobile phone will support the current content but won't let me read archives so I've been working on catching up. I found myself nodding and saying you preach it girl while reading some of the recent posts about why ER care costs more, why not to give advice over the phone, and why neither of those equates to a veterinarian who doesn't care. I was also very much in tune with the compassion fatigue post and the idea of becoming a small town librarian...right now, however, I'd prefer to become a hermit far, far away from my beloved family if I could only figure out a way to support myself and my herd without having to see anyone. EVER!!

Lately the sob stories about lack of money and how we don't care if we refuse to give away all of our services is really grating on my nerves. It doesn't help that I and my boss receive approximately 3 letters per week from an irate client who had a small dog that died last year. It's a crazy story and I still feel bad about it although even I can admit that it was not my fault that the dog died. The last time I saw the dog, it was having difficulty defecating because of a gi-normous sublumbar lymph node. I advised the owners that cancer was likely but they declined any and all diagnostics that were offered due to cost. I wound up starting the dog on antibiotics with the hope that it was infectious rather than neoplastic, advised laxatives to soften the stool, and sent some pain medication. On a side note, the dog had an anteriorly luxated lens in one eye with secondary glaucoma (lens was cataractous, cause of lux). Refused referral as well as enucleation so was forced to manage with anti-inflammatory. Working well and had given a bottle of atropine from our Good Sam supply (in date, returned because dog had passed away) with hope of dilating pupil, lens falling posteriorly where would be less painful, then constricting pupil to trap it.

The owners called after I had seen the dog stating she was no better to which I had to bite my tongue on answering, "Yeah, really! It's not like you let me do anything to help her and even if it is infection (ha, ha!) the antibiotics would hardly have had time to work!" They wanted to know if they should continue the medicine, I told them yes.

Apparently, they failed to tell me that she was "choking on the medicine..." She died the next day and they would not answer my calls but later accused me of not calling because I didn't care. Additionally, I am not a doctor, everyone knows I don't care for anything but money and didn't take care of their dog because they were not rich, I killed their dog and didn't care that the medicine was choking her, I gave them poison medicine, and hell is too good for me. This is repeated in each letter with slight variations on the theme. If it were not for the fact that the letters are being written by a little old lady in a wheelchair with cancer I would probably report them to the authorities but...sigh...I get it. I know how she must feel.

On a personal note, I'm finding that absence indeed makes the heart grow fonder especially when applied to family. I love my family, but they do make me crazy. I'm currently contemplating where and when I could run away at least for a while. The biggest problem is the herd.

The long lost prodigal son has returned home. He is telling the wildest story about dirty cops chasing him and filtering money through his bank account. I'm still viewed as the child therefore no one cares to hear my opinion which is that he has gotten hold of a drug causing hallucinations, etc. I'm even fairly certain of what he got but no one will support my efforts to get him to a doctor for a drug test. Yes, I love family. Especially the prejudice towards the male offspring that mine shows constantly. And people wonder why I have a personal prejudice towards marriage for myself. Just look at my role models then ask that question again!

Haven't talked to my friends much lately because I've been too down. Usually the more stressed and depressed I get, the more I withdraw. I'm just not good company; if I don't want to be around me, why would anyone else? Between work, family, patient loss or failure to progress, boss disagreements on how to practice medicine, and the loss of one of the herd, it's not been a good few months. Fortunately, the major storms jumped over us or that would have added yet one more thing to an already full plate. The tornadoes hit several small communities just a few miles from us but did no major damage at my home.

Speaking of the storms, it's really sad how some people have responded. So many stories of looters stealing what few possessions these folks have left or of trying to bilk them for services such as cleaning up the debris. I'm sure there are many stories of the good deeds too but it seems one doesn't hear those as often.

I didn't intend that this post become so gloomy but it seems to have a mind of its own. With that depressing note, I'll shut up for now and hopefully be able to write something more upbeat and maybe even funny next time.

Tuesday, May 10, 2011

I'd like two testicles with that...

It's funny how things seem to come in themes. Lately it's been retained testicles and heart murmurs. I've done more dog neuters with retained testicles (one or both) in the past month than I've done regular neuters. In fact, I can count on one hand the number of dogs that were "normal"... Funniest part is that prior to this I've only done a handful total.

The other thing that keeps popping up is heart murmurs. A PDA, aortic stenosis, and now a probable pulmonic stenosis. Just a little weird and, surprisingly enough, most of my clients are actually accepting the recommendation for referral and treatment. Wow... Now, I'm beginning to think I'm in the twilight zone or something.

By the way, Can't Spell - OS, OD, OU would refer to the eyes, not ears which would be AS, AD, and AU... Just thought I should point that out. Knew you would appreciate it.

Today, I did a C-section on a goat. Been a while since I've done that. Never fails to amuse me how little the actual procedure resembles the pretty, very tidy pictures in all the textbooks. One of the biggest kids I've ever seen; he did not live but hopefully mom will be ok. There's just no way to make that a completely clean / sterile procedure that I can figure out.

Wednesday, May 4, 2011

The following post...

...is shamelessly stolen from a coworker. Some details have been changed to protect the stupid...

*Phone rings*

Me: "Hello, how many I help you?"
Liqured up: "Hi, how are you?"
Me: "Um, ok, how are you?"
LU: "I have a question for you. Dont' laugh- if you laugh I'll sic my cat on you. He's really mean."
Me (trying not to laugh): "Ok."
LU: "Do you know anywhere I can get some cow blood?"
Me: "Excuse me?"
LU: "Cow's blood. I can't catch any fish and somebody told me if I mix my bait with cow's blood I'll catch fish."
Me: "Um, hold on, I'm going to transfer you..."

Gee, starting pretty early, arn't you? Before 8 am....

Sunday, May 1, 2011

More comments

I just had to add a few tidbits to May B. Insane's post...

1) yeah, I used to use "el" a lot as an abbreviation in school- it could mean electron, electrolytes, or electricity depending on the class...
2) I'm glad May B. can read her own handwriting because nobody else can...
3) Other fun abbreviations- OD, OS, OU- right ear, left ear, both ears respectively
4) I do like reader Outrider's comments- DIC can mean disseminated intravascular coagulation, dead in cage or death is coming...
5) another of Outrider's comments- CTD = circling the drain

We have a lot of morbid funny comments. Sometimes you have to be morbid to get through the day...