"October's Bright Blue Weather"

My brother and I learned a poem when we were very young and the first verse always stuck with both of us. Often, when taking "train trips" in the fall, we would look at each other then burst out with the words: "Oh, suns and skies and clouds of June, and flowers of June together; You cannot rival for one hour, October's bright blue weather!"

I'm pretty sure the title of the poem is "October's Bright Blue Weather" but please don't quote me. The rest of the poem is lovely as well but there's just something about that opening line that captures the essence.

Today, at long last, there is sun and blue skies. Admittedly, it is the last day of October and thus almost doesn't count but...it'll do. Most of October here has been gray and rainy with only a day or two that was sunny and nice. No, the sun does not make the badness go away but at least it helps one to feel a little more capable of facing the day. I miss "train trips" with my brother...

Not a good day...

I write this morning out of sadness. But, as is typical of me, I'll start on a tangential rabbit trail. I hate rain!! The older I get, the more this feeling grows. It's really weird because when I was a kid, I kind of enjoyed rain and would even go out to play in it. Now, however, I simply despise it and only want to hibernate with a good book and my four legged children.

That being said, today is unusual because we are having Fall Conference where veterinarians come and present topics as an opportunity for continuing education. The school is virtually shut down, only seeing emergencies. This worked out well for my plans since I would be able to go to surgery journal club then attend the presentations that I am most interested in as well as allowing me time to go home during the day (a rare novelty) to finish up on some things about which I've been procrastinating. (Me? Never!!) When I woke this morning, though, it was raining and horrid outside. I also had one of my lovely premonitions (if you will) where I just feel as if something bad is going to happen. I didn't go to journal club or any of the presentations yet, but have been hibernating.

Now to the real subject of this post. One of my really good friends from sixth grade e-mailed me a few minutes ago. Her mom has been sick, in the hospital with severe pneumonia recently but had gone home and was doing better. She was taken back to the hospital because she wasn't oxygenating well. They decided that she had thrown blood clots to the lungs and needed to be placed back on the ventilator. They sedated her for intubation and she apparently threw a fatal clot and died.

I hate the fact that I am hundreds of miles away and can't even be there for her. I can hardly believe that her mom, who was also a dear friend to me, is gone. And, as always in times like this, I know that there are not words available to express the sympathy that I feel for my friend. It also brings to a head the other scary fears of life such as the fact that I'm also a long way from my mother who is older than her mother was. And there are my four legged children who are getting older both here with me and at home with my mom. And there are the memories of those that have been lost before both years ago and recently...probably one of the reasons for my hatred of rain. And there are all my friends who are scattered around geographically (primarily because of my tendency to move so much of late) that seem so far away. Makes me think of a quote from one of my favorite authors that I'll probably butcher but something about the more people you care about the more captives of fate there are in your life.

Flat Broke

I should be used to the feeling of having no money. After all, I've been in school for more years than I care to think about and am now in the middle of my second (!) internship. At the moment, however, I'm very frustrated by being completely broke. The reasons are numerous extending from the very good (my dog needs a dental badly) to the selfish (there's a book I'm dying to buy). Unfortunately, there's no way that I can currently afford either, much less some of the less important things, unless I completely maxed out a credit card. The credit card cannot be maxed out unless it is a dire emergency (i.e. one of the four-legged kids needs something that can't possibly wait).

This being said, my meals have become increasingly creative as I try to wait out the days until the end of the month when I get a paycheck. You would be amazed at the things that you can dig up out of the cupboard and make a meal out of; things you would never have guessed can go together. Today, through a combination of a) not having money and b) not wanting to go to the grocery store, I decided that if I cook some homemade biscuits (very cheap) and creamed potatoes, I can live on that for the week without having to buy anything.

The picture that I included is totally plagiarized from an e-mail that I received recently and I would give credit for it but don't know who to credit. I thought it wouldn't be a bad idea if only my pets were that well-trained... So here's to cheap noodles and potatoes until the paycheck arrives on Friday. Now as long as no one gets sick, we'll be okay.

Happy Daze

Feeling a bit whimsical and nostalgic this morning; thinking back to vet school days that were actually tons of fun although a lot of hard work. Therefore, am posting a couple of pictures from freshman year of my little old lady, Choo Choo (9/11/91-12/19/08), with Dirk, Can't Spell's English Setter. When Dirk first joined Can't Spell, Choo hated him with a passion - he was, after all, a non-mannered, dirty, stinky little 7 week old puppy and everything he touched was contaminated! He stayed at my place for a while since Can't Spell's good ol' roomate didn't like the new addition. For weeks, Choo would walk around the places he had been, lifting her feet as if she were stepping in manure and circling widely around him or recent areas he had been. Then, suddenly, she decided she liked him and they were best buds for a while. It was only after he got to be about 20 pounds heavier than her that she decided she would no longer play with him... I guess all good things must come to an end. These are some of my "mostest favorite pictures ever!"

A Bad Run of Bad Luck

You know, we all have our ups and downs; trials and tribulations; peaks and lows; triumphs and agonizing defeats. It's not only part and parcel of life but part and parcel of our profession. As much as it pains me to admit it, we can't save them all and we are most definatly NOT all knowing or super heroes.

That said, I've had the worst run of bad luck with my hospitilized patients I've had since school!

Over-all, I figure I probably have a little better than 65% average with my hospitilized patients walking out the door. That's probably skewed a bit because I tend to only keep the REALLY sick ones because we don't have 24 hour care here, and my philosophy tends to be I'd rather have the pet at home where at least the owner can keep and eye on it and call the emergency clinic if it looks bad then having it here by itself. (Wow, what a run on sentance!)

So I only tend to keep the really bad stuff. The stuff that's sick enough I want it on IV fluids and the owners can't afford or won't refer to the emergency clinic for 24 hour care.

So, lets see. My dog that SURVIVED organophosphate poisioning only to come down with IMHA died. My pneumonia dog died. My last blocked cat died. I did have one cat in chronic renal failure that I diuresed that survived to walk out the door, but she's not doing so hot at home. And now I have another blocked cat in the hospital.

When he came in his BUN was 194, his phospherous was 11.something and his creatinine was 11.2. Oh yeah, and his potassium was >8.5. In non-veterinary terms that means that he's really sick. Fellow medical professionals probably read those numbers and said "Ouch!"

So I got him unblocked, IV catheter in place, urinary catheter in place, e-collar on, and medicated. Than he pulled all accouterments off overnight the first night. Dumb move kitty, those things were trying to save your life. The next morning and day he looked like crap all day after said accouterments were re-placed.

I didn't think he's be alive when I walked in this morning. He was; he stared at me out of the cage like he was murdering me.

I was never so happy to see such a "pissy" stare...

I hope he makes it.

Peeved

Man am I steamed right now!!! That's the reason for a second post in so short of a time.

I'm on emergency duty for the weekend and holiday. Over the weekend, one of us covers a 33 hour shift although we are allowed to leave the building if not actively seeing clients. I feel fortunate to know that there is someone else covering the night shift Sunday so that I get a little guaranteed rest prior to coming back Monday morning. So why am I PO'd?

How dare you plan to enter vetmed with the thought of it being a 9-5 job? Or set hours at all for that matter. My emergency student's shifts are split up from 8 a.m. til 5 p.m. then from 5 p.m. til 11 p.m. then on-call until 8 a.m. We had several emergencies show up at once and were in the midst of working them up with one leaving to go to their regular veterinarian shortly after 5 p.m. and the student just left because her shift was over!!!!!!! WAY NOT COOL!!!!!!!!!

For the first time since I've been here I got really mad and called the student. I got her voice mail and left a message chewing her out for leaving. I DON'T CARE that your shift is over; you have patients for whom you are responsible and you DON'T leave until you speak to me. I don't care that you told the other student you would be back later after getting something to eat. You DON'T leave until you speak to me first. If she had asked, I likely would have kept her for about 5-10 more minutes then told her to go let pets out, eat, whatever, and we could finish paperwork later. If she had only asked...

Goes right along with all the whining. I just don't get it. Maybe I sound like the proverbial "walked 20 miles uphill in the snow both ways" story but I have to say that I worked a whole lot harder than the majority of these kids when I was in vet school and I do remember it being a bit tougher. I would have failed had I walked out at the end of my shift without checking with the doctor in charge; as is she will get chewed out (gently may I add, I'm not a harsh or screaming type of person) by me and that will be the sum total cost.

Cats for change

Animal medicine is fun. While we do still catch some of the same things that human doctors get (pun intended) such as being a psychologist and hearing all about family woes, past illnesses, and other pets, there are definite bonuses to being an animal doctor. (Oh, and as previously alluded to in another post, yes, we do get asked to diagnose people illnesses.) One of the bonuses from my perspective is the often unexpected things that these little guys will toss our way.

I have been treating a cat with a pyothorax since last Monday. For those of you non-medical types, pyothorax is the doctor word for pus in the chest. So basically, the cat had an abscess inside his chest. It was lovely. Disgusting, chunky, stinky goo that I tapped from the chest first using a needle then we placed a chest tube so that I could drain it more often and flush it out. (Yes, I do have the usual female veterinarian fascination with abscesses. Not to say that men don't ever have that fascination but it seems to usually be a female thing. I have no explanation for that...)

The most common cause of pyothorax in a cat is a fight wound. This is likely in my little guy since he is a semi-feral kitten that was outdoors and just recently has become tame enough to handle. Pyothorax can go bad (VERY BAD!!!) because cats like to wall things off with fibrin which is a tough, collagen-like material that then stops the lungs and chest from expanding normally. This can be a permanent change leaving a cat that cannot breathe normally for the rest of its life.

Typical treatment of abscesses include flushing and draining, obviously not an easy thing when dealing with the inside of the chest. This is also apparently one of those "in vogue" types of therapies, also. By this I mean that we see therapies and diagnostic modalities go in and out of favor through the years in medicine. Flushing with sterile saline +/- heparin was originally used then became less commonly accepted and is now back in favor. The use of heparin would be to try to break down and prevent the formation of the fibrin. We chose to try this therapy since after removing 160ml of fluid the x-rays looked about the same as before although he was breathing better. This made us worry that he may have had a problem before anyone realized and may have had a lot of fibrin already.

We started antibiotics and flushing/draining the chest. He began to improve almost immediately although he had a raging fever (105.7F) the first night. After that, he began to eat and feel much better quickly. My original plan was to keep him on intravenous antibiotics for a week (so that I could be certain he received a complete dose) and to leave the tube in place for a week (to allow a window for reassessment of the fluid as well as draining the fluid). It would seem that the cat had other plans...

This morning we were unable to get the fluid back that we had put in to flush (a mere 34ml). We took another x-ray (unplanned) and found that the chest looked great. Clinically, the cat looked wonderful. We then discovered that the IV catheter was blown as well meaning we could not give the antibiotics through the vein without placing a new catheter. As so often happens, we then altered our treatment plan entirely based on the whim of a cat. We pulled his chest tube and IV catheter and switched to oral antibiotics. He's a much happier kitty now without the tube and IV lines. I think he was just making the statement that he is ready to go home! So, assuming there are no complications we will send him home. His owners can't pick up until Monday (out of town tomorrow) but I think Socks will be okay with that...or he could just make change in his little world again!