Freaky Friday

Its Friday, and that means I worked all day and it was crazy. I don't know why, but Fridays at my work are always madness. Today it was because one of our doctors was out with a family emergency, the elderly-parent-in-the-hospital variety. The other doctor's grandparent died, and will be leaving for a funeral ASAP tomorrow. The other two doctors in our employ were out of town on vacation and on maternity leave. Nose to the grindstone time.

I saw so many patients with such a dizzying array of problems today, as I sit down to dutifully blog my mind is still processing them. First was the poor little dog hit by a car last night, with such bad ocular trauma she'll probably lose her right eye. Her left eye will likely survive but was full of blood, so right now she's blind. Looks like she was struck on the right side of the face, then landed on the left, breaking several teeth. She had so much pluck, despite the visual loss and pain! Speaking of blindness, I saw a cat with hypertension-induced blindness. Also, a cat juandiced with hepatitis. A dog with Addison's disease (nonfunctional adrenal glands, which regulate your immune response and electrolyte balance). She was doing well, in for a check-up, owned by a wonderful deaf man. He brought along his (hearing) toddler son, and it was amazing to see them communicate in sign.

Otitis externa.

Conjunctivitis.

Flea allergy dermatitis.

Luxating patella.

Periodontal disease.

Lymphocytic Plasmocytic Stomatitis.

Obesity.

Osteoarthritis.

Upper respiratory infection.

Then the last: a sweet cat that I've only known a short time but really liked. His owners had moved from Florida after the hurricanes to New Orleans, and were greeted by Katrina. They landed here in Austin, seeking help for their diabetic, hyperthyroid, obese cat. He'd needed a dental cleaning for a long time, but it was put off several times with all the moving. By the time we got him stable and scheduled, I needed to pull 4 teeth.

Today he came in unable to walk. He'd developed cardiomyopathy, and that created a blood clot, which broke loose and was lodge in his distal aorta. It cut off the blood supply to one of his hind legs, causing paralysis and pain. Sometimes we can dissolve these clots, but the long term prognosis is poor. Most throw another fatal clot in less than 1 year.

They wisely elected to euthanize, and we all said a very sad goodbye. But then there were patients to discharge and ready for transfer to the overnight hospital.

Thanks to the help of my excellent support staff, despite the heavy schedule I got a lunch break and left only 30 minutes after close. I'll finish those last few records tomorrow...

Pet Meds

Hey, I really appreciate all the blog subject suggestions. Thanks to Chicken Flicken, I don't have to buy that book. I'll start with medications that animals take that humans also take. We are all mammals, with nearly all the same organ systems, just a few species idiosyncrasies, really.

Dogs and cats that get diabetes take insulin. Infections are treated with amoxicillin, cephalexin, clindamycin, etc - the antibiotics are all fair game. Heart medications are identical - vasotec, digoxin, lasix, etc. When your pet goes under anesthesia, the same cocktail you had may be used on your pet, and the same fluids drip in the arm. Even the same cancer drugs are used, expensively.

Its easier to talk about what animals can't take. Tylenol will kill your cat. Almost all of the human Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) cause toxicity in dogs and cats. Fortunately, we have veterinary specific ones that safely work well. NEVER give your dog or cat Ibuprofen (Motrin, Advil, etc) or Naproxin Sodium (Aleve).

Safe over the counter medications include benedryl (but the dose might be higher than you think!), chlorpheniramine, topical cortisone creams, neosporin, and saline eye drops. Aspirin can be given, but evidence shows that even in small doses, it can cause stomach ulceration.

Here's a real life story: I had a client with a cocker spaniel suffering from arthritis. I put the dog on one of my favorite NSAIDs for dogs: Rimadyl. This is a wonderful pain reliever, and can actually slow the progression of the arthritis if given regularly. I gave it to my own dog, Terlingua, for 5+ years. I give it post-operatively to nearly all my surgical patients. It is a safe, effective drug.

All drugs can have some side effects, and Rimadyl can cause a liver problem in a minute population of dogs. If this happens, the dog is very sick with vomiting and complete lack of appetite, so you wouldn't miss it. It is reversible (unless you ignore it too long and keep giving the drug). However, some people have gone CRAZY on the internet and written all kinds of bad stuff about rimadyl, with no scientific evidence, of course. One of these websites has a name like "Rimadyl Death" and has stories like, "My vet gave my dog rimadyl and he limped less, but I didn't like the way he looked on it, so I stopped it. He suddenly died 6 months later! I know it was that evil drug pushing vet and the rimadyl!" I'm not exaggerating.

So, my client returns 2 weeks later and says he's really upset about being given rimadyl. His dog was better, but seemed worse when he was "not under the influence of the drug." He could no longer go up and down the stairs. His wife read about how horrible this drug was on the internet, so he stopped giving it to the dog. However, he had been so painful he had to do something, so he'd given his dog a ibuprofen every morning the last 3 days.

I had been very calm, listening to his unfounded complaints, but when he told me about the ibuprofen I lost it a little, and blurted out, "Oh no! You didn't!" Then I told him we needed to check his dog's kidney enzymes and start all kinds of medications to protect his kidney and stomach! After I left the exam room, I literally beat my head with my clipboard. How could he stop a safe medication that had been working, and give something DEFINITELY TOXIC to dogs? If they had googled ibuprofen and dogs, they would have also known the real dangers of that drug. If only he had called me with his concerns, I would have been happy to address them. You can be sure I sent him home with lots of literature (which I probably should have done the first day). Luckily, his dog is fine, and is on a different pain reliever, since the guy is still skeptical of Rimadyl.

The moral of the story is, PLEASE call your vet before giving anything, even herbal supplements, to your pet. Most medications work, but the dose may be different. We'd much rather get a call BEFORE than AFTER an accidental poisoning.

Under the Wire

Whew! I thought I might not be able to post today. Blogger was down the first 12 times I tried to log on.

Not that I have a lot to say, but I feel the pressure of NaBloPoMo. I've never been one to just speak to fill the air with my own words. I usually prefer to be quiet until I have something thoughtful to say. Some might mistake me for snobby, but I'm just introverted. I prefer to say nothing rather than open my mouth and prove my stupidity.

Having to post all the time, I feel like I am at a cocktail party. Not one with all my favorite friends, but one where I hardly know anyone, and I have to chat them all up to impress them.

I am trolling my brain all day everyday for blog ideas, and discarding most of them. Anyone have any subjects they'd like me to expound on?

PG-13 stories

Thanks, all ye commenters, for your encouragement during NaBloPoMo! 1 week down, 3.25 to go!



Today I have some funny work stories for you. At my clinic, the foul language has gotten quite out of hand. We have a few employees that are quite colorful and creative with their profanity, and pretty soon it gets a little too contagious.

SO! At our last staff meeting, the hospital manager admonished us to clean up those potty mouths.

"Yes," said my boss in all seriousness. "Swearing just isn't professional. Oh Sh!t, I'm bleeding!"



Moving along, two of my adult coworkers were telling me today they went together to go see "Flicka." They were there with all the little girls watching the movie because they, too, love horses. Only one of them kept cursing during the "intense" parts of the movie, and was surprised when her companion kept shushing her, or that the mom in front of them turned around to give her the evil eye. (I told you that cursing was catching!)

At the end of the movie, they both started tearing up (because these movies are always emotionally manipulative and really drag out the sappy parts. That said, Anna and I were dry-eyed). Then my friends looked at each other, crying at this silly preteen movie, and started laughing at themselves.

Only now, they were laughing and crying, and it sounded like they were sobbing, SOBBING because HER DAD DIDN'T SHOOT FLICKA AFTERALL!


Hope I didn't spoil it for you.

Girls' Day Out

Anna's school was closed today, a kind of combined Veteran's Day/Teacher In-service thing. Colin's school was open, so we sent him off and spent the day together.

We went on a bike ride for exercise. Anna did really well. She still has a little bike with training wheels - a quadricycle - but has only recently gotten the knack of it. Today she gained confidence and longevity. We went about 1.5 miles! Afterwards she was tired, and happy to get into the bike trailer behind me, so that I could get a little more exercise than I did just coasting behind her.

Then we went to an early bird showing of Flicka, a pre-teen chick flick about horses. We snuck in our own popcorn. She sat in my lap most of the movie. It was cheesy and cliche, but we both enjoyed it, since we're both girls who love horses.

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I really jinxed myself with yesterday's post... I was awake, staring at the ceiling, 3-5 am. Grrr...

To sleep, perchance

Anna's been a little under the weather lately, and at night she's been getting up a lot more. I'm not sure if its the virus or the low dose of pseudoephedrine, but she has disturbed us multiple times the past few nights.

Well, disturbed us, but Anthony is the one who gets up and tends to her needs. He is more alert than me in the middle of a REM cycle, and he can also quickly resume sleeping (or snoring, as the case may be). If I am sufficiently roused in the middle of the night, it may be an hour or two before I fall back asleep. I'm tired, but not sleeping.

The multiple interruptions to our prescribed 8 hours really has an affect. I try to let Anth sleep in to compensate, but both of us are sluggish the next day. (I know it doesn't compare to caring for a newborn though, eh Joey?)

Dogs do not seem to be affected at all in this way. They can sleep at will, apparently. If I get up in the middle of the night, one of my canine companions has often padded out to accompany me. Sure, they don't have jobs to go to the next day, but they are just as happy as not to get up in the middle of the night and to get up early the next morning. Maybe they figure they'll catch a nap later, no worries mate. But, you can wake them from that catch-up nap, too, and they're again happy to go along with you. No post-nap grogginess or grouchiness.

The hormones of motherhood changed my sleep forever. I used to be a deep sleeper, now sleep has a much more fragile hold on me. The flick of lights across my retinas is enough to banish sleep. I can feel it drain out of me, like water from a tub, and I just want to stand over it calling, "Nooooooooo!"

I wish I could sleep like a dog.

Saturday sadness

This Saturday at work soon turned CRAZY as I did a work-in splenectomy on top of the usual busy schedule. OK, you guys know I get a real adrenaline rush with these surgeries. It was a huge 100 lb dog with a burst bleeding tumor in his spleen. We suctioned of 5.5 liters of bloody fluid from his abdomen before we could get to work. That's more than a gallon, folks! The surgery went as well as it could, and we transfered him to the emergency clinic just 1 hour after closing time. Unfortunately, it's most likely a hemangiosarcoma, a very aggressive tumor that will come back after just 2-3 months. Its the same tumor that took our sweet Terlingua. Her emergency splenectomy was on a busy Saturday, too.

Last Saturday I had an urgent case, too, that turned tragic. A little old lady brought in her dog for coughing and lethargy. A heart murmur was detected in August, but she didn't have money to work it up. When he started coughing, she gave him benedryl, hoping it was just allergies. I knew immediately it wasn't. Xrays confirmed his heart was huge and his lungs were full of fluid. Congestive heart failure.

I gave him a massive dose of lasix and put him on oxygen. I told the little old lady the goal was to get him out of this crisis so we could send him home on oral medications, but he might have to be transfered to the Emergency Clinic for more treatment before he became stable.

The little old lady's adult son had driven her there, and he told me that she had just lost her husband, his father, to congestive heart failure just 2 years ago. Watching this big, strong man who had loomed so large in their lives decline to nothing over a short time was extremely difficult for all of them. They weren't sure their mom could watch her dog go through the same fate.

I did improve the poor dog's condition, but he still wasn't stable enough to go home. In the end, they decided to euthanize him. I was a little disappointed, medically, but I knew it was the right decision for this family. Her two adult sons came to be with the dog when I euthanized him; the dog was obviously happy to see them, and they were obviously sad to say goodbye to him. His death was swift, peaceful, merciful.

It was sad but I understood. The dog had a terrible long term prognosis; I could maybe eek a few more months out of him. Seeing him suffer and saying such a long goodbye would be too painful for his elderly owner, would bring up too many painful memories.

I saw her again at the clinic this week. As I held her hand, she thanked me for helping her sweet dog. She told me how much she missed him, how "fast" he'd gone downhill, but it was obvious she was already healing. I embraced her and told her she'd made the right decision, letting her dog go last week. And, I really meant it.

Hypocritical

I was standing in line to vote early today. The woman in front of me saw her husband approach, and called out to him as he walked toward her, "Honey, I know we're going camping, but you don't even match!"

He was wearing: a black rugby shirt with a dark blue stripe, dark green pants, and black shoes.

He didn't match, but at least all the colors were in the same family.

She was wearing: a red ribbed sweater, navy knit pants - high waters, to show her fuschia socks, and black shoes.

Maybe they don't have a full length mirror at home.

'Shrooms, man...

I treated a cute little puppy today who was quite sick. She went out into the yard and ate all the mushrooms she could find. Then she came in and vomited her cute little guts out (vomited 8 times in less than an hour). Her owners adopted her just 2 weeks ago but already are totally in love with her, and they were very concerned.

They brought me vomited up previously chewed mushrooms in a ziploc bag. "I can't really identify these; I'm not a mycologist," I said. The owner said, "Its obviously some sort of puff-form fungus, with internal gills." I said, "You sound like you know more about it than me!" and she blushed and told me she was a biologist.

I knew we had to treat the puppy immediately for the nausea, and put her on fluids to flush any toxins out. We gave her a large dose of charcoal to absorb anything that remained. The owner sent me a digital image of some more mushrooms she found in her yard. They were a relatively nontoxic type, and should not cause any liver or neurological problems. To be safe, I sent her home with a liver protectant.

The puppy was beginning to return to her bright, perky self at the end of the day. She started out looking bleary-eyed, nauseated, and lethargic. Didn't seem like a very pleasant trip to me...

Hey, big spender

The tooth fairy got caught up in Anna's excitement at losing a tooth and left a Sacagawea Dollar. For my English readers, we Americans don't have any coins in regular circulation over 25 cents. A few years ago a beautiful golden coin was released with a portrait of the Native American woman who help Lewis and Clark explore the west. But people complained that it was too similar to the quarter in size, and too hard to carry around, and there was not room designated for it in cashier drawers or vending machines. However, they are not at all heavy compared with carrying a few pound coins in your pocketbook! So now, you hardly ever see Sacagawea dollars, and they tend to be hoarded and not spent.

Apparently, the tooth fairy overpaid. This morning Anna told me she was expecting maybe a dime and a nickel.