Wednesday, March 29, 2006

Birthday photos

This is the birthday girl this morning, wearing her new dress and new necklace, admiring the cake Anthony made her in the wee hours last night that I won't let her eat for breakfast.

She requested pizza for dinner, so I made a selection of pizzas on the grill (in the foreground - goat cheese and red pepper, then prosciutto and sage, and in the background - pepperoni, Anna's favorite). After a few slices, she asked, "Is everyone finished? Can we have cake now?"

Tuesday, March 28, 2006

Happy Birthday, Anna

Tomorrow my baby girl turns 5. F-I-V-E. Which means five years ago today I was blissfully unaware that my pregnancy was about to end, that nights waking up every hour to pee would be exchanged for nights waking every 1-2 hours to nurse. Why did I ever think I had to wake up, turn on the light, and get my boppy pillow out, and nurse that baby SITTING UP while I struggled to stay awake? Oh yeah, because I felt like I had to make sure she was actually eating. Finally one night I decided I could lay down and nurse her, and even doze.

Five years ago today, I was browsing a gift shop and nearly bought my unborn daughter a little trinket with a faux diamond, the birthstone of April, since my due date was April 7th. At the last minute I put it back, which was quite fortuitous because who knows when I would have had the time or energy to exchange it.

Anna is so excited about her birthday tomorrow - she can't wait to open her gifts, and knows exactly what kind of cake she wants her daddy to make her (lots of icing roses). She is also PUMPED about her "Cowboy-Cowgirl" birthday party on Sunday, and especially the ponies coming for pony rides, although she wants to keep one for good in the backyard.

She is so precocious when she talks, using grown up phrases and gestures -- "Just a little bit," she'll tell me, with her eyes half-closed and her head nodding knowingly. She's so grown up, she blows me away, so that I can't even remember what she was referring to.

But how perfectly I remember her as she was when I brought her home, no longer than my forearm, spidery eyelashes on bruised little eyelids, vanilla-sweet brown hair on a warm, round noggin, tiny fingernails and crooked 4th toe on her right foot, and how I fell endlessly, deliriously in love with her.

Sunday, March 26, 2006

Little Buzz

Colin is pretty into Toy Story and Toy Story 2 these days. He especially likes Buzz Lightyear. He frequently says, "To Na-fiddy...and Beyond!"

He took it to a whole new level last week, when he was running around shirtless. He said to me, "Mommy, look my Wingspan!" Then he punched his nipple (his "button") and shot his arms out to the sides.

"Very impressive!" I told him between the giggles.

Tuesday, March 21, 2006

Cancer in Dogs

Cancer is the #1 cause of death in dogs. In people, it is heart disease, then cancer. In cats, its kidney disease, followed by cancer. My household is a statistic: I lost my cat to kidney failure, and both dogs to cancer.

Not all canine cancer is hopeless. I am currently treating 2 dogs with chemotherapy for lymphosarcoma, a cancer of the lymph nodes that has a relatively good prognosis with treatment. I also recently had a successful case of Mast Cell Tumor:

Happy Post Operative Patient

This cute little pug had a tumor on her right front foreleg. Dogs often get mast cell tumors - tumors of the cells that contain granules full of histamine and other mediators of inflammation. Most mast cell tumors can be cured with wide excisional biopsy - meaning you cut out a lot of surrounding tissue, so that you get clean borders, and its gone. Occasionally we see dogs with mast cell tumors that are of a higher grade - much more aggressive. Those come back with a vengeance. Fortunately, most are grade 1 or 2.

This cutie-pie came in with a large, diffuse tumor over her forelimb. Consider your forelimb, with a tumor on it the size of a cookie. Now imagine to get rid of it, I have to cut the tumor out as well large amounts of skin and tissue around that tumor. You can imagine the difficulties closing the skin on this wound.

When I approached this girl's tumor, I mentally told myself not to think about closing the tumor when I cut it out. I just focused on removing it all. After it was gone, I thought, Oh man, now what am I gonna do? There was a huge gap that exposed muscle and tendon. Closing it simply would put the skin edges under too much tension. Tension causes pressure on the capillaries; without blood supply, the skin edges die -- and definitely do not heal.

When I approached the wound as a puzzle, it seemed a little more possible. I made a few tension releasing incisions, and closed the wound in a zig-zag pattern. I pulled the skin together with tension-relieving suture patterns. I used all the tricks I knew, and I still thought the skin at the center corners may not survive.

Immediately after surgery

Fortunately, this girlie did well. The biopsy came back low grade with clean borders. Her skin actually healed well! I rechecked a small swelling last week, to make sure there was no return of tumor. We all breathed a sigh of relief when there were no mast cells seen.

Close up 1 month after the initial surgery.

I don't know who was more pleased with the outcome, the owner or me!

Sunday, March 19, 2006

Working through the grief

After four very depressing days, the fog is starting to lift, at least in my head. The weather here has been foggy, grey, and muggy, and does not lift the spirits at all.

The kids are doing fine; they have been much more concerned about their weeping parents than anything. Anna even helped her dad dig Montana's grave - not an easy task in this drought-hardened soil. I did have to tell Anna to stop talking about the "puppy" she decided we were going to get next, and what kind of collar we would buy it. Although we won't be dogless forever, I am not ready to think about another dog yet.

I did have to work on Thursday and Friday this week, but fortunately I do work somewhere that people understand what kind of loss this was. Indeed, my coworkers have had a loss, too; they were attatched to her since she came with me to work everyday since her diagnosis last September. When I got to work on Thursday their were beautiful flowers already on my desk, and later one of my clients sent me cookies from a bakery that delivers them warm from the oven. Since I hadn't eaten anything for a long time, when they arrived I scarfed FOUR of them before sharing with the staff.

I have also been touched by the many comments on my blog. People who knew my Montana in life and on-line have written so many nice things. It helps to know Montana had many fans, and that I share this grief with others.

Leigh-Ann wrote me "to suggest that you put up a link to your preferred animal charity in your blog sidebar, as I'll happily make a donation in Montana's memory. I'd rather send a donation to a place you're supportive of than just some large, faceless national charity." This generosity blew me away, and its taken me a few days to come up with an organization.

Montana was, in all respects, the penultimate Golden Retriever. She was beautiful and sweet until the end. Because she embodied the ideal of the breed, if anyone is inclined to make a donation in her name, please contact Gold Ribbon Rescue, helping Golden Retrievers in Central Texas, by clicking the image below.

I'll write Montana's eulogy when my heart is calmer.

Wednesday, March 15, 2006

Goodbye Faithful Friend

We euthanized Montana today. It was an agonizing decision, but she was mostly already gone. She was ready to go, even if we weren't ready to see her leave.

I've cried so much today my face aches.

Tuesday, March 14, 2006

Spring Breakdown

It has been so long since I've seen my sister Steph and her twins. We decided to go to Houston for Spring Break, so we could spend more than a hurried weekend together.

The last time I saw Steph she came through Austin at the end of her frantic Hurricane Rita evacuation. Our visits seem to be punctuated by disaster. I remember one trip when we were both pregnant (me with Colin) and I got severe food poisoning and spent most of the time in bed.

This trip started out with Colin taking a poop in the upstairs playroom within minutes of our arrival. While we chatted with Steph's husband - who was of course serving us fine French wine - I totally did not hear Steph's cries for help until she was screaming my name. A turd had rolled out of his shorts, he stepped on it, and tracked poo all over the playroom and stairs.

We really know how to make an entrance!

Montana was staying with a coworker, who soon called me to let me know Montana had several seizures. Then later she called to let me know that Montana was not doing well at work - instead of chilling under my desk, she was pacing, wandering around the lab and up front, ignoring them, howling, peeing, and having more seizures. They medicated her, and she seemed a little better. Anthony returned early and picked her up.

Anthony called me last night and told me how bad things were. Once she was home, she was having many petit mal seizures, didn't know her way around the house, didn't even know her name. He took her to the emergency clinic where they bumped up her phenobarb and gave her more steroids. That seemed to settle her down.

Oh yeah, the pet sitter for our cat and chickens called to tell me one of the chickens escaped and was killed by a dog on the greenbelt. At least it was one of my least favorites (I can't help it, I like some more than others, and no it wasn't Chicka the China the Chinese Chicken). We still have 5 hens.

Steph's car broke down and she had it towed to the dealer. Fortunately the Highlander has that 3rd row so we actually could put all of the kids and moms in one car to go to the zoo. I know Steph felt very handicapped, though, without her car.

The plan today was to go for a group cousin portrait then head back to Austin early. Steph and I were sad to truncate our plans, but we were adult about it. Then Paige woke up with a fever, but with Motrin seemed good to go. Then Colin suddenly vomited. A large quantity. All over Steph and her couch.

Colin was limp after the vomit was over and cleaned up, and went down for a long nap. Paige, who had been pretty cheery, turned into a weepy feverish sad creature who only wanted to slump on her Mommy. Anna and Graham tried to understand and played trains and "painted" the house with water. Colin woke up much better, and we all enjoyed a late lunch in the beautiful afternoon sunshine.

Oh, and to console ourselves we ate pie. Lots of pie. 3 kinds.

I picked up Montana tonight and she seemed great. She recognized me and listened to my commands. Back at home, she had another hour of petit mal seizures and pacing. She's better now, sleeping.

I said to Steph, "I'd like a visit with you that doesn't involve hurricanes, life and death of animals, and lots of poop and vomit." She said, "We are getting lots of reminders that we really aren't in charge, eh?"

We did have a lot of fun eating, going to the zoo, and eating, and swimming in the pool at night, and eating. I bet I gained 5 lbs on all that fantastic food. And pie.

Happy pictures coming soon.

Thursday, March 09, 2006

A Bad Patient

Sometimes when I meet someone at a party, they'll ask me, "What do you do when a dog is really bad?" And I usually tell them that I work with wonderfully trained people who can properly restrain most dogs. But if they're just vicious, I tell them, I'm sorry, I can't touch your dog and I don't treat it. Then the people are usually shocked but hey, I'm no Crocodile Hunter! I got bit in the face once already, and that was unprovoked. Most dogs I know don't lie, and if they tell me with body language and snarls they're gonna bite me if I get closer, I believe them.

Today such a beast came into our clinic. I was actually the last one to see him at our clinic - for annual vaccinations - and this was how it was accomplished: the owner pulled the leash of the muzzled growling dog through the crack of a door, and my nurse squeezed the door against the dog and the wall. With the dog thusly restrained (and spewing poop, pee, and saliva everywhere), I jabbed him in the back with my sedative. 20 minutes later he was imitating a bear rug, and I did a quick exam and gave the vaccines.

Today the dog came in because he progressively went from lameness to unable to walk on his hindlimbs in a few hours. He had to be brought in with a sling under his hindend and a muzzle on his front end. Because he was undersocialized as a pup, he lives in fear most of his life - today he was in sheer terror. Apparently he is a nice enough dog for the owners at home, but he was struggling and slinging his head around so much he clocked his owner on the cheekbone and left a gash. Any attempt at restraint made him flail his body, front end trying to snap at anyone, hind legs not supporting him so they were dragging and forming a pivot point behind him. The doctor stood in front of him murmuring, "Stop, just stop. We're trying to help you," but the dog did not believe it. The doctor did not want to sedate him so that she could do a proper neurological exam, but he was too much of a danger to our staff, and in the end she had no choice. She knocked him out.

She talked to the owners. Either he slipped a disk or had a fibrocartilagenous embolus (like a stroke to the back). Either way he needed a lot of medication and nursing care for several weeks (expressing the bladder, turning him, physical therapy - and he's a big dog). There was no way we would be able to hospitalize him, so it would be up to the owner to do it all on her own...

The owner really loved her dog, and at first was determined to give him a chance. But after about an hour, she realized if he got fractious at home, there was no way she could handle him, and then how could she even get him to our clinic?

In the end, she made the difficult decision to euthanize him. Not every dog is a good candidate for treatment, even with a good prognosis, and this guy was guarded at best. We all felt sad for his short angry life, that we couldn't help him, and for his owner. As bad as he was, her grief for him was real.

Tuesday, March 07, 2006

Time Warp Day

Most days I make my mental list of things to do, and at the end of the day have maybe 25% accomplished. The day slips through my fingers, and there are still toys strewn about the living room.

Today, I think the universe ran backwards. At work, we did 7 surgeries in about 5 hours. This is mostly due to the awesome nurses I work with, getting patients ready, finishing the paperwork, etc, and the fact that most of the stuff was routine, straightforward, and uncomplicated. Well, I did pull 17 baby teeth out of a chihuahua today, and a cat neuter ended up being cryptorchid (one retained testicle that I had to search and destroy), but still, overall a smooth day, and I left a little early.

At home, I emptied the dishwasher, swept, took the kids to the park, came back and made an easy dinner. Anth was gone at a meeting, and Colin seemed a little under the weather, so quickly I bathed them and put them to bed. Early. By myself.

This never happens to me! Whatever biorhythms I got today, I'd like some more, with unlimited refills.

Monday, March 06, 2006

Look Ma, No Braces!

My sweet cousin Beverly had a momentous day today. After 5 1/2 years, she finally got her braces off. She got them on so long ago, she doesn't even remember the day they put them on -- back when she was 10.

Anyone who had braces will never forget the day you get them off -- before it comes, you feel like once they are off, you will finally feel grown up. But after they finally do remove them, you can't get over the sensation of how SMOOTH your mouth is, how BIG and ROUND your teeth are, like gigantic fat marble columns in your mouth. And your lips! They feel like plush velvet curtains going over them, and the nap must be 12 inches thick! Its a weird sensation. Neuroscientists would say after so many years of spikey brackets and hard wires, your neurons completely desensitized to such roughness that when they are presented with normal, the smooth sensations are way over represented. (Does that make sense or did I have too much wine with dinner?)



To celebrate, Colin and I took Bev and her mom, Cinda, to Chuy's for some seriously good Tex Mex, where Bev didn't have to worry about getting salsa in her brackets. I thought about letting her just eat an apple for lunch, since she hasn't had a whole one in over half a decade, but then thought Chuy's might be easier! She even got to test drive the Hybrid Highlander today.

Bev with Colin and Vino

Friday, March 03, 2006

Sibling Revelry

Anna went on a little trip with my mom this morning. They went to Waco to see my Grandmother and Great Aunt Sudie. Colin was heartbroken to be left behind this morning and cried his heart out. Nana had offered to take Colin, too, but he's not as easy as Anna (due to his age). As much as we would have enjoyed an evening to ourselves, Anthony and I know man-to-man coverage is better with these guys.

When I got home from work, it was just my boys here to greet me. Colin told me a little bit about his day, and Anthony told me that Colin had been great. It was so easy to deal with just him, "I feel like a professional babysitter!" Anthony told me.

Anna called me after dinner and told me about her exciting day, then requested to talk to her dad. Colin heard us on the phone with her, and said, "I wanna talk, too!" Finally, we passed him the phone and witnessed our kids' first sibling phone conversation.

A: Hi, Colin!

C: Hi, Anna.

A: Hi, Colin.

Me: Ask her where she is.

C: Where ah yoo?

A: I'm at Grandma Dulce's

C: I wanna go to Peter Piper Pizza, too.

A: Yes, Colin, this one has a train, I think you will like it.

C: Bye, Anna!

A: Bye, Colin, I love you so much!

Later I was putting something away in Anna's closet, and I heard Colin exclaim at the noise, "Anna!" He came running in her room, but he was satisfied just to play with the cars he left in there, and with Vino the hamster. His portable crib is still set up in her room from Nana's visit, and he decided to sleep in there tonight.

Anna sounds like she is having a great time. She said she got an extra toy to bring home for Colin. I'm so glad these two like each other so much.