Just Breathe

I have some retired clients who really love their yorkies. As their old dog was winding down, they got a new puppy. "We forgot how much energy puppies have! He's too much! But we already love him."

When they finally lost their geriatric dog, I know the new puppy was a great comfort to them. He came in last week for booster shots, wriggling with zest for life.

Today they called and said he chewed through a Christmas light cord and was shocked. They rushed him in and did "mouth-to-mouth" in the car. He presented limp, cold, pale, and shocky. I was relieve that he did not have an electrical burn in his mouth. Xrays showed that he did have significant damage to his lungs - the shock causes fluid to fill the alveoli.

The little pup lay on a circulating warm water blanket all day, breathing in O2. All his energies were focused on breathing and healing. We treated him with diuretics and bronchodilators, but mostly he needs time to get better. He has to get better - I don't think these people could take another loss.

When you get the Christmas lights out this season, please watch your small creatures, and be aware of the dangers of electricity.

Notes from Colin's teacher today

Note #1

Dear Mr and Mrs Vetmommy,

Colin pulled his pants down in front of his friends and peed on our big tree in the playscape. Could you please talk to him about it.

Thanks,

Colin's teacher




Note #2

Dear Mr and Mrs Vetmommy,

Colin was chewing on the turkey baster and continued to put it in his mouth after I talked to him about it. The tip is all chewed up, and I told him he was responsible for bringing the class a new one.

--Colin's teacher



Two notes in one day - ay yai yai! "How come I never got any notes when I went there?" Anna asked, all jealous. Believe me, Anna, you don't want to get notes like this! Neither do I!

Less than Perfect

When I was in vet school, someone gave us a lecture that was supposed to be humorous at a student convention. He was an older vet who was a little jaded by general practice. He told us that he alerted his staff to pain-in-the-butt clients by putting an "A" with a circle around it on the front of their files. He thought it was brilliant, because if the owner saw it, they would think they were A+ clients, but everyone who worked there would know that they were a-holes from his crude symbol. Like I said, he was supposed to be funny, but he really just made us more wary of practice, and unapologetically showed us how mediocre he was.

He also said, "I guarantee every one of you will try to spay a tom cat and put an IM pin into your palm when trying to fix a femur." He knew that in a busy practice how easy it was to check an animal in for a spay, have your technicians prep it for surgery, and not realize until you were digging around in there for way too long for a non-existent uterus since the cat was actually a "HE." Damn, and you could've been at lunch already, since cat neuters only take about 5 minutes. Fortunately, I have never made this particular mistake, but I can see how it could happen. As kittens, the female and male genitalia look almost the same (especially on orange cats), so the owners may at the beginning think their cats is the opposite sex (and name it accordingly). Four months later before the big surgery, you should examine the animal, listen to its heart, but you might not actually inspect the privates. 60 minutes later, you are scrubbed in and presented with a cat, shaved and scrubbed for ovariohysterectomy, so that's what you try to do...

The old guy's prophecy has not come true for me (yet). So I would not think too poorly of a vet that accidentally tried to spay your male cat - if that was what was asked for, and as long as he only charged for the neuter, not the spay. Also, no vet should ever try to spay a male dog, since there is a big prepuce in the middle of their abdomen.

The other half of the prophecy hasn't come true either - although I can see how whilst trying to force a steel pin into a femur you could ram it right through the other side and into your palm. I don't do much orthopedic surgery, thanks to much more skilled surgeons being close by.

I have, however, made my share of mistakes, and I hope you'll forgive me for not exploring them further. Each one is too painful to recount, especially recent ones -- nothing fatal, thank god. This is the difficult part of the job for me, not dealing with death, which is usually a mercy, but when my lack of intellect or lack of attention causes an animal and its owner suffering. That's when I wish I had an easier job, not when it gets busy or when staff drama gets out of hand. Making a medical mistake makes me question everything.

Choose your words

Colin and I went grocery shopping today after I picked him up from school.

At dinner tonight, he said, "Mommy, can I have dessert?"

Anthony said, "We don't have any dessert."

Colin said, "I want ice cream."

Anthony and Anna both said, "We don't have any ice cream!"

I was so proud of my little boy, who although he is just 3 1/2, and not as articulate as his sister, clearly communicated to everyone. "Yes we do!" Colin said. "Mommy picked one out at the store!"

I rewarded the little tattle tail with an ice cream cone.

Its not TV. Its "Sex and the HBO."

Its been a great long holiday weekend. I'm ready to get on the couch and veg with some DVDs. This NaBloPoMo is wearing a little thin... thank goodness there's only 4 more days to go.

Anthony and I rented all the "Sex and the City," DVDs when they came out. We were too cheap to sign up for HBO, so we anxiously awaited the release of each one. I don't know how HBO subscribers could be satisfied after watching a single 30 minute episode. We always loved watching several, back to back.

When "Sex and the City" was over we were sad, and moved on to "Six Feet Under." Oh my God! what an incredible series. The characters were so rich, the story lines so fascinating and arching. The writers were true through the many years, and never forgot where their characters had been or what they really wanted out of life. Soon we were anticipating these DVDs in the mail as ardently as we had "Sex and the City."

So we called it "Sex and the Dirt."

Then "Sex and the Dirt" ended - and what a magnificent finale! I was sobbing at the end of the montage that shows you the ends of all the characters lives. How brilliant to show what happens to all these people we knew and loved, and especially to show their deaths since that was the other focus of the show. The next day I watched it again and again.

It was so great to enjoy and agree with the ending of a beloved series (both "Sex and the City" and "Sex and the Dirt") after being acutely disappointed with the endings of so many other network shows that I loved (Northern Exposure, Mad About You, Seinfeld, and Friends). Did they hire a completely different team of authors to write those other finales? Maybe the regular writers quit or moved on, so they just hired anyone off the street.

So now, we are hooked on "Deadwood," set in the 1800s gold rush town of the same name, written and directed by David Milch. He also did NYPD Blue, another favorite of mine. The style - jangling story lines and complex circuitous dialogue - is the same in both series, despite very different settings.

So we call it, "NYPD Sex in the West."

Another birth story

Back in my first year of practice, when I had to take emergency call and carry the dreaded beeper, I did several c-sections. Whenever a patient would try to have its litter but stall out, I'd give oxytocin injections to try to jump start that uterus but it never worked. By the time I saw them, surgery was inevitable, with one exception.

Once I saw a little white rat terrier, bloated with pregnancy. She'd been trying to push out the first puppy for several hours, but he was stuck. I gave her oxytocin, lubed her up, and helped pull the big puppy out. It was too late; he was already dead.

I chatted with the owners while we waited to see how her labor might progress. She was a young dog, and her owners were very sad about the dead puppy. I could feel that she had one large puppy still inside her. Nothing seemed to be happening, even after a second oxytocin shot. I feared her uterus was spent and that we'd have to do a c-section to get the last pup out. I decided to examine her one more time.

This time I could just feel the puppy's head. Female dogs have a contraction reflex: if you stroke the dorsal vaginal wall in an outwards direction with a crooked finger, they will have a contraction. It is appropriately called "beckoning." The young mother responded - she still had a little bit of push left in her! So, using more lubrication, I coaxed more contractions out of her and moved the puppy into the birth canal. The owners became very excited. Soon we could see the head in the sac starting to emerge. Using one hand to pull the puppy's head and the other hand's finger to beckon more contractions, she slowly made more and more progress until - BAM! - the puppy slid out. I pulled open the sac and rubbed her down. Mom got interested and began licking the puppy.

The dog owners were overjoyed to have a healthy, alive puppy without surgery. "We'll name her after you!" they said.

Caesarian fun!

Today at work I had a scheduled C-section. This doesn't happen often in our world, but when it does, its usually a bulldog (as was the case today). Bulldogs have been selected by their breeders to have large blocky heads that get stuck on the way out. Most puppies are like little fusiform sausages and are easily pushed out. Bulldogs are more like humans with big noggins that are likely to get stuck. All the c-sections I've done in my career were either bulldogs or little tiny dogs like chihuahuas or yorkies, who don't have the energy to push their puppies out. They usually need emergency c-sections due to uterine inertia.

I had not previously met the owners of today's patient, but apparently they have bred Cairn terriers before and had been to many whelpings. They were very reluctant to turn their dog over to me for the c-section; they wanted to watch. However we are not at all set up for an audience in our little surgery room. Besides, I knew there were 5 puppies, which meant at least 5 nurses in there reviving them. While I am pretty open about doing procedures in front of clients, the last thing I needed was these 3 people in the room, questioning everything ("Is that good or bad? Are you supposed to do that?"). Its not like a human delivery room where the dad (or which ever SINGLE support person) is standing by the mom's head - this would be lots of people who view this dog as their child, and I could tell already they would be touching my sterile field.

I assured them I would keep them as involved as possible and that I would take good care of their baby.

The poor mother-to-be was quite uncomfortable and already in the early stages of labor - pacing, nesting, gagging, grunting. Soon we got her under anesthesia and rolled her on her back to prep her huge protruding belly, the many nipples huge and prominent standing up on the surface.

I had an audience anyway. All the staff stopped by to see the enormous gravid uterus once I pulled it out of the abdomen. Humans have a T-shaped uterus, with one baby (occasionally more) in the main part. Dogs and cats have a Y-shaped uterus with fetuses packed in a row along the "horns." This girl's uterus was about 3 feet long end-to-end, full of pups. I made an incision in the middle and milked the puppies out, one by one, dropping them into the arms of a technician, who revived them.

In short order, all the "quintuplets" were out, squirming and breathing and mewling. Now I was all alone, sewing up her already shrinking uterus and closing the long line on her deflated belly.

Momma woke up after snoozing for about 45 minutes after surgery. She was sitting up looking at me, more relaxed than before the surgery. "Look what I have," I told her, as I brought one of her pups out of the heated padded box they were incubating in. As the pup was aloft in the air it squeeked out. As soon as she heard her baby's cry, that momma stretched out on her side, exposing all her big teats. Soon all 5 pups were attatched and nursing, and momma closed her eyes contentedly. Three boys and two girls.

In Summary...

The menu:

Smoked Greenburg Turkey

Cabernet Sauce

Mushroom and Herb Dressing

Roasted fall vegetables (including a butternut squash we grew!)

Autumn Succotash (with edamame instead of yucky lima beans)

Wild Rice Pilaf

Pumpkin Pie

Pecan Pielettes

French wine

4 generations around one long table in my dining room!

I'm too tired to write anything else....

Thanksgiving Eve Photos

We've been getting everything ready for the big feast, happening at our house this year. Today Grandad arrived, and our cousins Paige and Graham, Auntie Steph and Uncle Al soon after for a little extended family celebration. The cousins have all been anticipating this get-together, and it didn't take long to get them warmed up.


Artists, hard at work


My new helper, Paige, helping me make the arugula insalata.


Cousins!


Cousins in the tub! Won't be able to do this much longer...

Anna Conda

Sunday was so beautiful, I took the kids to the park for a picnic lunch. Afterwards they played a long time on the playscape. There were 2 other children there with their dad, close to my kids' ages. I said hello to their dad from a distance, then called my parents on my cell phone to finalize Turkey Day plans.

After I'd been chatting for 30 minutes, I saw the other dad hollering at his daughter, then haul her away by the arm. He was shouting to me, "Your daughter is in it, too!"

I told my parents I'd call them back, and said, "What?"

He said, "They found a condom. You may want to wash her hands."

Eeew, yuck. That is totally gross, but now this formerly friendly dad was dragging his kids to the water fountain to rinse their hands then to the truck. His daughter was crying that she didn't want to go home.

Anna came up to me, quietly weeping. She said she wanted to go home. She was crushed that this other dad had yelled at her. My heart instantly went out to her. It seems like this happened to me a lot as a kid - some other dad yelled at me, and I felt ashamed and terrified. I mean, it was scary enough when my dad yelled at me, but I usually knew what he was so mad about. When somebody else's dad yells at you, you feel terror and want to just die.

"Oh honey, you didn't do anything wrong," I told her. "Its just those things are really gross and he didn't want you guys touching it. You didn't know; its not your fault."

Anna said, "I thought it was just a dirty white balloon. What was it, Mommy?"

I said, "It was a condom, and they're pretty gross, so that's why he yelled, so you wouldn't touch it."

Anna said, "What's a Conda?"

Now, we're getting into touchy territory. I want to be honest without giving her more scary information than she needs. She already suspects its something shameful from the other dad's reaction. I need her to know the shameful part has nothing to do with her.

I said, "Its something that grown men put on their penis, and its pretty gross. It should not be left at a park where kids play. Its not your fault that it was there."

Anna asked, "Do men like Colin put it on their penis?"

I said, "No, only grown men."

Thank goodness she did not ask about men like her daddy. I held her hand all the way home, and then you can be sure we both washed up thoroughly!