Wednesday, January 27, 2010

End of Day

We spent the weekend at a Bed & Breakfast with old friends.   We were so looking forward to the break, although I think they needed it more than us, since they are dealing with an almost 3 year old and a 10 month old who hasn't been sleeping much since she's been sick the past few months.  Anyway, it should be  called a Bed & Dinner & Breakfast, since it includes a chef prepared 3 course meal at 6 o'clock for all the guests.

My clinic stays open until 6 pm, and my last appointment is scheduled at 5 pm.  But, you know, its medicine, and stuff happens, and I'm not always out of there on time.  However, if I get all my records done as I go and end up with a softball of a last appointment, it is totally feasible that I could get out of there by 5:30 and be toasting the weekend with friends by 6.

My last appointment was "blood in urine" which certainly is straightforward.  The patient, an older cat, had two previous bladder infections in her history.  Piece of cake.

"She's been incontinent for a few days," the owner told me.  "She is constantly making small puddles everywhere."  Of course, the discomfort of infection makes for frequent small urination.  It all fit; I could get a urinalysis, confirm the diagnosis, dispense antibiotics.

Except.  On exam her bladder was enormous, full like she hadn't peed for a day.  She was dehydrated.  And although she was quiet, when I listened to her chest she was grunting with every inhalation.

This didn't add up.  I took her back and confirmed by ultrasound that it was indeed her bladder that was huge, then collected a sample with a needle.  Then I took her out to manually express her bladder, but even when I squeezed as hard as possible, I only got five drops out.  That meant she was obstructed - either with crystals and infection (common in young male cats) or had a tumor obstructing her.

Back into ultrasound, I looked again at the bladder wall.  It was all stretched thin, except going down toward the urethra - there it was thickened and irregular.  Another vet came by, confirmed what I was seeing, and said maybe I could hit the wall and get a little sample with a needle.  The ultrasound helped me guide my needle to the right spot.  I looked at the sample under the microscope -- cancer cells, everywhere.

I explained my findings to the owner.  As she realized how grave my words were, she turned in front of me so that I saw the back of her head but she faced her cat.  I know she was hiding her emotions, but I had to give her the rest of the bad news to her back.  "The tumor is inoperable where it is.  She's suffering, and I likely won't be able to catheterize her.  I really think you should euthanize her."

"Oh no," she said quietly, "I can't do this.  My husband always takes care of this part, and he's out of town, just got a new job out of state.  I can't handle this.  Can it wait until Monday?"

"No, she's much sicker than that, and I'm sure she's vocalizing because of her discomfort.  The best I can do is drain her bladder with a needle and you can take her home overnight, and bring her back in the morning.  But I think it is better to let her go now."

I felt so sorry for the woman, who clearly wasn't expecting to make this heavy decision.  She, too, thought she was bringing her cat in for a simple infection.  I left her alone to make some phone calls.  She couldn't reach her husband, but did reach her adult daughter, who helped her make the right decision.  We took care of the paperwork, and then I gave the cat a sedative.  Usually I leave the pet and owner alone during this time, but she kept asking me questions until I finally realized she did not want to be alone.  Once her cat was unconscious, she said goodbye and left, then I administered the final injection.

Sigh, 6:10 pm.  It was not how I intended the end of my day to go, but I know the owner didn't think her day would end with the loss of her cat, either.  It is not the kind of decision that you can rush, either.  Fortunately for me, I only missed the salad.  

Monday, January 25, 2010

Sweet Charity

A former client of mine is a fireman.  Former because his beloved dog died this year, and they aren't ready yet for the next one.  His wife made a lovely Christmas card that had family pictures on the outside, and a montage of dog photos on the inside with a memoriam to him.  It was sad and beautiful and made me cry.

The fireman came in with a buddy from the firehouse and the dog that the firehouse had adopted.  He was an old lab mix, about 10 years old.  A good samaritan dropped him off at the firehouse because they found him as a stray driving home from the hospital with their newborn baby.  Understandably, they did not want to drive all the way to the shelter, but knew one of the firemen so stopped there.  (FWIW, I don't think I would stop and pick up stray dogs on that first car ride home; that is one good samaritan!)  The fireman tried to find his owner, but had no luck, and of course loved him too much to take him to the shelter.

The dog loved the firemen, too.  Within two weeks of his arrival, the dog knew the routine.  When they got a call, he'd run down to the fire truck and run around as they got ready to go.  When they returned, they could hear him barking happily inside, so happy that all his new friends were back.  It was the only time he ever barked.

The chief said they could keep the dog, so they brought him to me for vaccines and a check up.  They knew he had a dental problem.  In fact, his first name was "Stinky."  He was sweet natured, but his breath was foul.  I lifted his lip and found terrible periodontal disease.  The gums were receded from nearly all his molars, exposing the roots which were dripping pus.  No kisses for me, please!

We vaccinated him and ran senior bloodwork -- all healthy except for those teeth.  A dog from a firehouse comes with limited funds - this one had one person volunteering to pay for heartworm prevention, another paying for food, another for shots.  However, I knew he needed about $1100 in serious dental surgery.

After speaking to our hospital manager, we decided to do most of the dental work pro bono.  I was so excited to tell the firemen, and they were happy, too.  I put "Stinky" on some antibiotics and scheduled the appointment for the following week. 

After 7 days of antibiotics, he wasn't smelly anymore, and his gum tissues were healthier.  I knew that would make his healing go much better.  It took 3 hours to extract 9 molars, fill them with synthetic bone graft, and suture all the sites closed.  It was a lot of work, but it is my passion, because I know I can help a patient like this feel SO MUCH BETTER and be much healthier in the long run.

"Stinky" did great on recovery.  Although my patients are totally anesthetized, I always block their nerves with a long acting local anesthetic, so they wake up numb.  Within an hour, he was wagging his tail and taking a brief walk to relieve himself.  Although I pulled a lot of teeth, it must immediately feel better to have all those aching abcesses removed.   On his post-op phone call, the firemen reported he was doing great, back to normal the day after surgery, and had much more energy.  Such a happy outcome for a hard-luck dog and the public servants who love him!

Tuesday, January 19, 2010

Still here

Everything's fine, I'm still alive and well, just tired from being single working parent for week #2 now.  I don't know how you soloists do it.  And, I had my husband for the weekend, too. Anyway, stories to tell, maybe manana.  Must veg on couch now with glass of wine.

Monday, January 11, 2010

You can always talk about the weather

Who would have thought that the worst, hottest summer in history would have yielded to the most glorious fall in memory, then such a cold winter?  Heck, I thought that interminable summer would never end.

I remember Decembers where I wished it would be cold enough to wear a sweater or jacket, when I thought Target should sell Christmas T-shirts in a short sleeved version.  I saw them this year, but did not feel like buying one, since we'd already broken out the coats, scarves, and gloves.

For the past week we've sunken into the freezing temperatures gripping most of North America.  Although I love the cold, I fear for my Meyer Lemon tree, which I have grown to love, but may not survive.  It is amazing for me to see frost on my car in the morning.  Anthony did some landscape work this weekend, and the mulch was still frozen underneath in the afternoon.

This morning I jogged around Lake Pflugerville and it was only 28 degrees.   There was lots of sun and little wind so it was glorious.  The far edge of the lake had a rim of ice, and the marshy areas were icy enough for the many birds to walk on.  The great blue herons were hunkered down, feet in the frigid water.

The days are getting longer, and two of the hens are laying again.  Their water bucket is in the shade, perpetually iced over.  I go down and bring them some fresh water, and all 5 run over and communally take little sips of it.  They look like they are tasting a fine wine!  It must be good because they taste it again and again...

Wednesday, January 06, 2010


Have you seen these crazy bloggers who wear the same dress for a year (or at least many months) in protest of the fashion industry?  The thought is that we don't really NEED all these new clothes every new season, that fashion is a contrived way to keep us consuming.  Sure, everyone loves a new frock, and it makes you feel pretty and special, but you don't need a new wardrobe every 6 months.

While I have absolutely no desire to wear the same. dress. every. day. it did get me thinking.  (Also, Anthony got extremely bored with the meager yet efficient selection of clothes I brought in my big backpack on our last Europe trip, and still cringes when he sees a certain skort.)  I was thinking about this especially when I was putting away 2 weeks worth of clean laundry (hey, it was the holidays, I got behind), cramming everything into my walk-in closet and drawers.  I have plenty of clothes.  Do I really need more?

So, I resolve not to buy more clothing for myself until my birthday, in May.  Its a big birthday, and will require a new frock.  I have recently stocked up on underwear and socks, and got some shirts and sweaters for Christmas.  I've got 3 pairs of good, in-style jeans (not mom jeans).  I wear scrubs two days a week, and got two new sets in November.  The only thing I didn't get before 1/1/01 was some new yoga pants to wear to Bollywood, but really that is only once a week; I can manage with the old pairs.

I may make an exception for a new bathing suit as the weather gets warmer.  Of course, I can always buy my kids more clothes -- they outgrow them and really do need new stuff every season.  Plus Colin wears out the knees!  I'd rather buy my kids clothes than me anyday.

Of course, today dressing for lunch with girlfriends, I was totally jonesing for some new tops.  Must stay strong!

Monday, January 04, 2010

Happy New Year, Happy New Decade

Hi, how were your holidays?  Mine were great, thanks.  I took a holiday break from the internet.  I hardly checked blogs or facebook or twitter or email.  It was nice to disconnect.

The kids go back to school tomorrow, and we had a great break.  Anna had another wonderful performance at her annual Christmas ballet.  I worked a half-day on Christmas Eve, then my work gave me the best Christmas present ever - we actually closed on Dec. 26 (I had been scheduled to work).  Working the day before and after Christmas is not unreasonable, I guess, for someone in health care, but I got a little holiday thrill every time I thought about NOT going to work after all on Boxing Day (not an actual US holiday, sadly).  Therefore, I serendipitously only worked two full days and two half days during the school break.  SWEET!

My sister Emily joined us on Dec. 23. My parents came for Christmas dinner.  They love a big English feast with roast leg of lamb (me, too).  Anthony, sadly, is not a lamb-o-phile, and loves beef tenderloin.  There must have been a Christmas angel on my shoulder, because I was able to cook the lamb in the high temp oven and the beef in the low temp oven, let them rest while I made Nigella's perfect roast potatoes, and magically they were all ready at the same time and perfectly done.  My mom helped me make an amazing sauce/gravy from the drippings of both meats, steam the asparagus, and set the table.  My dad carved the lamb for me, and Anthony and Emily get an A+ for washing up! It was especially nice how it all turned out since I burned my hand at Christmas breakfast and the hollandaise curdled, twice.

It was a Star Wars Christmas at our house.  Both kids seemed pleased with their loot, although both are skeptical about Santa.  Anna said, "It was the best Christmas ever!  They get better each year!"  So sweet and sincere.

When all my family left on Dec. 26, I felt like a little kid all disappointed that Christmas was over, except instead of being sad that all the presents were all opened, I was sad they were all leaving and there were no more celebrations to look forward to.  However, we did have a great post-holiday dinner with former nanny Jessica (now in law school in Chicago), and visits with Anthony's parents, niece, and nephew.  We had a New Years' Party with lots of finger food, sparkling apple juice for the kids, and prosecco/cava/champagne for the adults.  There were also impromtu get togethers with other family friends and cookie making.  I'm still a little bummed that it is all over.

And remember Y2K?  Can you believe that was 10 years ago?  Back then I had no kids, no experience in dentistry, and so few of the friends I see regularly now.  My thirties were amazing.  Here's to the next decade!