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.


mr man said...

Ok. I'll stop complaining about meetings and people breaking processes now.

Did you ever get your cape? You deserve one.

Lula said...

High Five, Girl! You must make your parents so proud. :)

Anonymous said...

What a full, exciting day! One thing I am curious about...couldn't one of the techs have placed the IV cath in the hypoglycemic puppy and given the dextrose while you worked on the other case? (Assuming they're licensed.)

Fledgling said...

As a vet student, I love reading these kinds of posts...makes the studying not seem so bad.

Vetmommy said...

Anon, yes, in Texas even non-licensed techs can place IV catheters. The technician tried once and was unsuccessful so decided to let me try before blowing any more veins.

Fledgling, thanks! Being a vet is much better than being a student. Pays better, too.

EdamameMommy said...

Phew! What a day. I agree with mr man, you are like mighty mouse. Here she comes to save the day, Vetmommy is on her way!

Anonymous said...

Lula,Yes, she does make us very proud! We are in total awe of her skills, compassion and GRIT!!! She is amazing.

And yes, where or where is your cape???

Love you, sweetheart!

mainlyclearskies said...

Wow! I hope that when we, one day, find a dog to call our own, we can find a vet as good as you!