Monday, April 25, 2011

The Lesson of the Grasshopper

Thanks for all your kind comments.  I really do have a great job, even if it is stinky and messy and exhausting sometimes.

There was another super-cool case last week I have to tell you about.  The Tuesday I was so busy with surgeries, my co-worker saw a cat who was gagging and had a change in her voice.  She was hoarse and vocalizing a lot.  She wasn't eating and was quite dehydrated.  She had a full work-up (bloodwork, Xrays, etc) but nothing was obvious.  Her signs were so non-specific - did she have a gastrointestinal problem?  a tumor in her oropharynx?  a neuro issue?  She was sent on IV fluids to rehydrate at the emergency clinic, then back to me the next morning.

She was doing better, but definitely hoarse.  "MRAHhhh- Owwhh," she rasped at me.  The plan now was to anesthetize her for a complete oropharyngeal exam.  Once morning appointments were over, I gave her an IV sedative, then grabbed a laryngoscope to anesthetize her.

These exams usually reveal nothing, then we have to refer them for endoscopy or CT for a more thorough look.  If we do find something, its usually a tumor - unhappy news.  However, as soon as I peered over her epiglottis, I knew there was SOMETHING!  "She's got a foreign body!" I hollered.  "Quick, someone get me a swab!"  Under a large clot of mucus, there was something crossing horizontally over her larynx, under one laryngeal fold and over the other, like a toothpick skewering an hors-d'oeuvre.  I grabbed it with a hemostat, and revealed........

a Grasshopper leg!  A disarticulated leg, in its full chitinous spiny glory.  It looked a lot like this:

Except it was more yellow.  It was incredible.  We all did some high fives.  I called the owner, and she was relieved to have an answer and that the ordeal was over.  The kitty must've caught the insect while hunting, then go this appendage stuck.  Grasshopper's revenge!

Thursday, April 21, 2011

Last week was a pretty amazing week at work.   Hectic, but one that makes me so happy to be a vet.

On Tuesday, we had a full schedule, but I saw an emergency before I got started on surgeries - a very sick pit bull who had not eaten anything since Thursday, and had lost a lot of weight.  The owner told me he had taken this dog in 3 months before from his dad who had passed away.  He loved the dog, a last living remembrance of his dad, but he didn't know any vaccine history.  However, one feel of his abdomen and I knew:  this dog didn't have parvo, he had an obstruction.  He needed an expensive surgery, and I knew this owner had money issues - he told me when I walked in the door.   We called a charity clinic, and they said maybe they could work him in the next day, but by then the dog would be dead. I pared down the estimate as much as possible, and took $100 off the top (we're allowed to do that once every few months), but it was still too much.  One of our hospital managers raided our charity fund, and that lowered it to a level the owner could make a deposit and then leave held checks for the rest.  We were on!  We were going to save this dog's life!

I put the dog on fluids to rehydrate him before the surgery, and then got started on getting my scheduled surgeries out of the way.  Meanwhile, a hypoglycemic puppy was rushed to the back.  I was giving orders for the technicians who were taking care of her while I was pulling a tooth, just until the other doctor could see her... but clearly that was not going to happen in a timely manner, so when I was done I took her case over, too.  I placed an IV in her tiny vein, gave her a dextrose injection, and watched the limp deflated puppy come back to life.

Then a technician told me about a case that was dropping off for an afternoon appointment -- it was a cat who could not pee.  Seriously??? This is a medical emergency, not a case that can wait until the late afternoon slot reserved for it.  Sure enough, this male cat had a total obstruction.  So, as soon as I finished the current surgery, we anesthetized him and I started the procedure to catheterize his urethra and relieve the obstruction.

An hour later, he was still stuck.  I had tried 7 different kinds of catheters and many techniques with no progress.  For the first time in 16 years I was unable to get the catheter in.  I called the specialty surgeon, and he said yeah, if you can't get it catheterized with all that you've done, something is wrong.  He needs the surgery to open up his urethra and turn it into a short, wide one.  He said he could see the cat immediately.  I had to call the owner and admit defeat, and explain that her cat needed a surgery done at the specialty hospital, and could she please pick him up and take him there now?  She was disappointed but came and got him.

Finally, after one last spay I was ready for my big exploratory on the pit bull!  I opened his belly and found that most of his small intestine, which is supposed to look like a flat, pink hose instead looked like a bloated swollen purple summer sausage.  I found the obstruction and removed it - a pungently rotten corn cob.  Unfortunately at least a foot of intestine in front of the obstruction was dead - it was blackish purple and was not squeezing and moving like the rest of the intestine.  I removed the dead section, but the proximal portion was dilated about 3 times the distal portion, and I have to connect these two ends perfectly so that they seal and don't leak, because that would cause peritonitis.  To fix this, I have to cut the healthy, skinny end at a steep diagonal, until the two circumferences are equal.  With my assistant holding the two ends, I suture them back together with tiny knots all the way around.  As I am finishing, the proximal edge of my anastamosis is starting to look purple.  I am so worried that it has lost its blood supply and is going to die.  Its not leaking, and most of it is moving with normal peristalsis, except for this one bit...  Now we've been working on this dog for nearly 2 hours and his blood pressure is dropping.  I decide the repair is good enough, flush and suction  the belly, then close him up.

Now I have 3 appointments who have been waiting for me; they did not want to reschedule or see the other doctor.  This is extremely complimentary, but also very stressful, because I hate that they waited for so long (over an hour), and it means more work for me.  I finally finish the last appointment at 7, an hour after closing.  I send the pit bull to the emergency clinic for overnight care, asking them to please keep costs as lean as possible, and explaining the less than ideal appearance of the gut at the end of surgery.  The doctor there seems to have a poor opinion of my decision to leave gut like that in the belly, then breezily says, "Well, I guess if it (the intestine) dies, you can open him up again tomorrow."   Sigh.  I really really don't want to do that, but I will if I have to.

The next day the pit bull is back in our hospital, and his belly hurts but he's eating, and his temperature stays normal all day.  No vomiting.  I send him home with some donated medications and a prayer.  I called him twice the next week, and he was still eating and keeping it down.  Apparently everything must have healed back together after all.  The referral surgeon called to tell me the cat had a long 1.5 inch section of his tiny urethra that was impacted with grit.  There was no way he could have been catheterized, and surgery was his only option.  The hypoglycemic puppy went home and so far, with small frequent meals, has not had a recurrence.  What a great, but exhausting, day to be a vet.

Thursday, April 14, 2011

This blog is not dead!

I've just been writing other things.  Specifically, papers with titles like Surgical Extraction of an Upper 4th Premolar in a Dog or Endodontic Therapy of a Fractured Maxillary Canine Tooth in a Dog.  Riveting stuff.  I am required to write four journal-quality papers on some of my cases for the Fellowship in Veterinary Dentistry that I am pursuing.  They were due on April 15 for pre-approval.  Can I just say, writing these things so far away from school was painful.  I'm far from school in years and distance, and these things needed references!  Anyway, I worked on them for months and months.  They needed medical records, photographs and Xrays attatched, and had to be submitted on 5 different CDs in separate folders.   I got it done.

I hope they are good enough.  Four veterinary dentists will review them, and they need to get a 80% to pass.  My mentor (the dentist now in residence at Texas A&M vet school) said he did not pass the first time he submitted.  Fingers crossed!  Then, I can submit a large packet of my case logs, CE hours, equipment, library, etc etc, in July.  If that passes, then I can sit for an exam!

Loads has been happening around here - Anna had a birthday, both kids had a great informal piano recital, Anna did her fourth Royal Academy of Ballet graded exam, Anthony put in a fabulous summer garden, and we've been pre-approved to adopt a dog from the Golden Retriever Rescue group.

To be continued...