Career Day

Anna and Colin's school doesn't allow them to dress up for Halloween.  The week before Halloween this years was "anti-drug propaganda" week.  After days of dressing up in red, wearing crazy hats, and wearing crazy socks (as in, sock it to drugs!), the grand finale was to dress up as what you want to be when you grow up on Friday.

Anna said she wanted to be an actress, and needed some crazy sunglasses.  I told her that was fine, but if she wanted to be a surgeon (another career she is interested in), she could wear the adorable scrubs my mom got for her.  She was sold!

Colin said what he always says lately.  "I want to be an ocean scientist."  I had anticipated this, and suggested he wear a lab coat, a long pair of swim trunks, and a shirt with an embroidered shark.  He decided to add some tools - tweezers, a mini wrench, and his giant squid model - and he was set.

They were pretty psyched on Friday morning, walking out the door with nametags (made with the label maker and old nametags of mine) that read:

Dr. Anna M.                                                            Dr. Colin M.
XYZ Animal Hospital                                             Ocean Scientist


They looked so good, the principal even took pictures of them.  I was so thrilled that they both chose science careers!  Well, except for that brief flirtation with acting.

Don't Know about NaBloPoMo

Its November 1st?  Should I do it?  Feeling unsure.  Last year I crashed and burned, but then again, Fran was in town and ALL my free time was spent having crazy fun.

I don't know that there will be much more free time this year.  There are ballet rehearsals every weekend.  Incoming relatives and a family reunion.  We are planning an kitchen remodel.  Right before my favorite food holiday.

At least there is lots to talk about.  I may give it a try.  But Anthony's out of town all week, so I'm already driving solo.  And writing in incomplete sentences!

Halloween Mask?

I have a lovely client, one of the best when it comes to her pets.  She is attractive and generous.  She drops them off twice yearly for comprehensive wellness checks.  She sends us trays - no, PLATTERS of delicious food from our local gourmet grocer at Christmastime; just when we are about to die from sugar overload she sends us cheeses and kabobs and spinach dip, etc.  The entire staff loves her.

She's been dropping her cats off for the last year and a half, so I haven't actually seen her in a while.  When she came in last week to pick her newest kitty up, I ran up front to say hello.

I didn't recognize her.  Her upper lip was puffed up like a duck's, her brow was creepily smooth.  She was supernaturally tan with white skin under her eyes.  Her hair had been uber-highlighted, and perky breasts cleaved under her V-neck.

"You look so tan!"  I sputtered.  She said she's been hanging at the pool with her friend and a new baby.  I tried not to stare at her lips as she spoke.  Why would such a beautiful woman  - beautiful inside and out - do this to herself?  The puffy upper lip was especially distracting.  Everyone agreed she looked not younger, but scarier.

I will never understand why women choose to mutilate themselves this way.  I hate growing older and losing my youth, too, but botox and restylane et al don't fool anyone.  I think most women just go in for a little injection, then pretty soon they're checking out with a full meal deal.  Those plastic surgeons are good salesmen.

Just say NO!

On again, Off again

Saturday I saw a dog who had eaten a bunch of pillow stuffing the previous Sunday.  Throughout the week, his appetite and came and gone, as well as some intermittent vomiting.  But Friday night he refused to eat, then vomited a lot overnight.  So Saturday his concerned owners brought him to me.

I took some abdominal Xrays, and saw what I expected: a very full stomach, empty gassey intestines.  For the stomach to be full in a dog that had not eaten in 24 hours, I knew something was amiss.  I diagnosed a gastric obstruction - much better overall than an intestinal obstruction, but still, a surgical problem.  I told the staff to prepare for a surgery.

The owners asked me if it was still in the stomach, could it be removed endoscopically?  Clearly, this would be preferable to an open abdomen.  There would be fewer complications and a faster recovery. But we don't have an endoscope, so I called our referral surgical center.

"Yes!  We can do that procedure!  Are they coming soon?" was their first response.  Then I got a call back requesting the Xrays.  Since I can send them digitally, they soon called me again.  "You know, with something fibrous like stuffing, and with the way those Xrays look, I think we'll work on this patient for 3 hours, pulling little bits up, then send them to surgery anyway.  It will be much longer and more expensive than surgery alone."  The owners understood, and asked if instead we would do the surgery.  So we were back on.

I was excited about doing an exploratory gastrotomy, even if it was after close on a Saturday.  "Couldn't we just give this dog something to make it vomit up all the stuffing?" my technician asked.  "Silly Susan," I said, "He's been vomiting all week.  It's not coming up."

Our pre-anesthetic medication contains morphine, which makes a lot of patients vomit.  The dog urped up a little stuffing.  "Oh, well, I guess now we know we're doing the right thing with surgery," I said.  Then he HEAVED about 4 times, bringing up a stomach sized amount of disgusting polyfoam stuffing.

We took another Xray, and sure enough, empty stomach.  I called the owners.  "Wow, you are fast!" she said. "No seriously, did we forget to sign something?"  When I told her about the very productive vomiting, she was very happy.  I sent the dog to the after hours emergency clinic for some monitoring, but he went home that evening, free from stuffing AND surgery.

While I was gone

I was gone most of last week, at the annual Veterinary Dental Forum.  Its my conference, my people, all teeth, all the time.  The week before Anthony was gone all week; he left again this morning, back on Friday.  It's the new normal.

While I was gone he sent me this great group of pictures.  Colin, after sticking to his scooter far too long, finally learned to bike on his tiny heavy beginner bike.  Once he had that down, he soon took to stealing Anna's 5-speed.  Even though it is pink, it was far superior to what he'd been using.  Anthony got him his own bike -- in blue, much better -- and left it for him in the garage with a note saying "To Colin, Love Mom and Dad."

After Colin got home on Friday, a beautiful Texas fall day, he ditched his school things and went out to the garage.  He started wheeling Anna's pink bike out when something caught his eye.

 Now he's jumping up and down and squealing.

 He's a pro already!


Can't you feel his joy?

Chewy the Hamster

On Sunday Anna asked me to look at her little hamster, Chewy, because her eye was tearing.  There was a swelling on the right side of her face/neck causing the problem.  The swelling was pretty soft and movable.  I figured she had an abcess or a cheek pouch impaction - that hamster is always shoving huge things in her cheek pouch.  I promised to take her to work the next day to lance the abcess.

When I got there the next day, the hamster's swelling was worse.   I gassed her down, then explored her cheek pouch with an otoscope.  It was empty and otherwise normal.  I felt this swelling, which felt much firmer now, not so fluidy.  I aspirated it with a needle and no pus.  Clearly this wasn't an abcess; it was a tumor.

This was going to be a big task, so I decided I needed to bring Chewy home and talk to Anna about it first, and also let her see her hamster before the big procedure.  "Yes, do it, if it will keep her from dying!" Anna said earnestly.  Well, maybe it will keep her from dying, and maybe not.  She might die under anesthesia.  Anna was tearful but still gave consent.

The next day after all my regular surgeries were done, and during my lunch hour, I sedated Chewy again.  The tumor had grown significantly again overnight.  Now it was pushing her mouth to the side.  With one technician holding a miniscule mask to her face, and another monitoring her heart and respiratory rates, I cut the skin over the tumor.

Sometimes there are benign, well-encapsulated tumors that peel right out.  A few times, when people are willing to spend money on their pocket pets, I have done these surgeries with great success.  This was not going to be one of those surgeries.  This massive tumor was irregular and had adhesions to everything.  It was extending under her eye and ear, into her oral cavity, down to her shoulder, shoving her trachea up and over like a snaking river.

Delicately I teased the tumor away from the vital structures.  I feared that if I hit a big vessel beneath (the carotid or jugular) she would rapidly bleed out.  My technician noted her heart rate slowing.  We added heat support and adjusted her gas.  It was frustrating that I could not intubate her and ensure her airway, or give her IV fluids, but of course that would be impossible with such a small creature.  After 45 minutes I had the mass about 3/4 of the way free, but Chewy developed a lot of edema (swelling) around her contorted trachea, and she expired.

The whole clinic was sad, for the little hamster and the girl who loved her.  When I got home, Anna burst out of the house, and I gave her the bad news.  She cried, hard, for about an hour.  When she had regained some composure, she said, "I know its not your fault, Mommy, I know you tried.  I'm glad she died while she was under anesthesia, so she wouldn't be in pain." Anna never ceases to amaze me. She also asked me to thank the technicians who assisted me and helped Chewy, and for the coworker who had made a precious clay momento with Chewy's pawprints.  She held her pawprint clay to her heart, and asked me if I would have her cremated ("I want to have her burned.").

Poor Chewy certainly couldn't have lived more than a few more days before that tumor would have choked her.  I was surprised how well Anna understood that.  Chewy was a "rescue" hamster that we got from a girl who basically ignored her once she became a teenager.  Skittish at first, she became quite friendly and curious, and let all kinds of children hold her.  She was in our home for only 4 months, but I think they were good ones.

My passion, my pup

Sunday Francesca was chewing her nightly "boney," her rawhide chew, when she suddenly stopped.  She kept bringing it to me, which was annoying.  "Go eat your boney, I'm watching a movie," I told her.  But she wouldn't eat it, and kept nudging me for attention.

She went to bed with her boney.  And carried it around the next morning.  "What is wrong with you?" I said as I lifted her lip.  Then I saw that she had broken her big molar, and there was a large red spot where the nerve was exposed.

AAAAaaaahhhh!

I am collecting cases as I work on my dental fellowship, but I did NOT want to practice on MY dog!  Poor Francesquita, no wonder she couldn't eat her boney.

Fractured teeth are very common in dogs, and this tooth is the most commonly fractured.  If the fracture exposes the pulp, or nerve, of the tooth, there are only two choices:  extraction, or root canal.  Do nothing, and eventually the pulp will die and fill with bacteria, and the tooth will abcess.  Meanwhile, its painful and unhealthy.

I got myself mentally prepared to perform the root canal.  Its a complicated, 3 rooted tooth, and I don't have as much experience with fixing it as I do single rooted teeth (like the fang).   Also, it is awkward working on your own dog, if you think about it too much.  Anthony put it in perspective for me, though, when he said, "What is the worst that could happen?  She could lose a tooth?"  Right.

So today, I fixed it, and it was the best I've ever done.  Just like in a human root canal, fils are introduced into the pulp chambers in each root:

Then, using progressively larger files, all the organic material/pulp is removed.  Once its cleaned, the pulp chambers are filled with an inert material called gutta percha:

Then the holes you made in the tooth and the rest of the crown is restored with composite.  The tooth is dead but functional.  Once it fractured, it would have died anyway.

Francesca is woozy and drunk from the morphine, but she is painfree tonight.  That is my gift to her; she gave me a great case to work on and a little more self confidence.

Treasure

Lots of good bloggy ideas in my head.  Little time or energy to get them out.

But look at this gift I got today!  I have a wonderful client who has gifted me with some of her gently used things, like a Waterford crystal bowl, Italian table linens, and a Lladro figurine.  (Can you tell she doesn't have a daughter?)  But today she gave me a gift I will really treasure:

Those are hand knit socks! Merino wool with just a touch of cashmere! Such beautiful tiny stitches!

I can't wait for chilly weather!

(PS these are NOT gently used.  They are brand new, never worn, knit just for me!)

The Next Installment

In Chile, we met another vet friend of Fran's, Catalina.  She was vivacious and friendly, and when she heard we were interested in going skiing, instantly volunteered to take us -- any excuse to hit the slopes.  She also had two daughters very close in age to our kids, and could loan us clothes and equipment.  She made it hard to say no.  So we made plans, and pre-bought lift tickets to get a discount.

Then, Colin started vomiting at around 3 am and continued every 45-60 minutes thereafter.  Anthony took one for the team, and stayed home with the sick boy while Anna and I went up the mountain.  Here's Anna in the car:

It takes about an hour to get up to the slopes.  We were so high!  Above the tree line!  Los Andes were SOOOO beautiful.  Here's Anna and I, just before her lesson.

Anna did not get taught very much in her lesson.  However, it did give Cata and I some time alone on the slopes.  I hadn't been skiing in nearly 15 years, but was pleased to learn it was like the proverbial bicycle.  I forgot how FUN skiing is!

And this resort was incredible.  Efficient, modern lifts, and so many runs!  We had access to 4 large areas of trails.  And no one was out there -- usually I skied right onto the lift.  The longest line I encountered was 4 people long.

Look at those beautiful mountains!  No trees makes for safe, wide runs, but it was so very bright.  I was grateful for the goggles Cata loaned me.  After lunch we had a few slow runs down the bunny slopes with Anna, and Cata tried out her snowboard.  Here's the only picture I have of her that day, my ski angel, taken by Anna after our last run.

I also forgot how very uncomfortable ski boots are, and how great it is when you take them off at the end of the day.  Skiing in July!  Incredible!

The next day Colin was BTN (back to normal).  He wasn't sad about missing skiing, just sad that he missed the snow.  Fortunately, Fran's mom, Carmen, and her uncle, Felipe, planned to take us to his rustic little cabin in Cajon de Maipo.  There was snow!!!

I love this view of his adorable cabin, with the mountains reflected in the windows.

Felipe lit the gas for his oven, and we heated up the empanadas we'd brought and opened the wine.  Felipe and Carmen speak about as much English as we do Spanish, but we had a lovely meal together, and a lively conversation.  Colin and Anna went outside to have a snowball fight, then we all went on a hike around the area.  It was a beautiful day.

We were also invited to be the guest speakers at Fran's niece, Elisa's kindergarten class.  The kids were supposed to ask questions in English, but they asked in Spanish.  They loved Anna, and asked her what her school was called, and what her friends were called.

Anna said, "Heather... Katherine...Benjamin...Vannida...Christina... umm..." A little boy said, "Tienes solo cinco amigos?"  (you only have 5 friends?)  It was hilarious.  We also sang them a little song we knew from her school in English and Spanish. 

What else did we do?  We ate out a lot.  One of Fran's favorite restaurants is Tip y Tap, a little Chilean restaurant that we loved for its dining room with windows that overlooked a play ground.  One wall had a forest scene, so here's Fran and I, correr en el bosco!

Here's what Fran liked to order:  tartar.   Fran! Someone forgot to cook your hamburger!

Here we are eating in a Patagonian restaurant with Catalinda.

This is from a high-end steak house where we ate with Fran and her brothers.  Oh man! that grass fed beef is good!  We started with Pisco Sours, then had wine, steak, and salads.  At the end of the meal, every table got a complimentary plate of cotton candy.  It seemed hilarious to us to get circus food at such a fancy place.  Good thing the kids weren't there to get so silly on all that sugar!

There is one last thing I have to post about, the amazing tiny winery we visited.  Until next time...

They're back from the wild West

Ok, I hear ya, clamoring for a post.  Our children returned from their 2 week visit in New Mexico with my parents.  They had a great time, going horseback riding, hiking, visiting Carlsbad Caverns, the El Paso zoo, and Peter Piper Pizza four times.  They also brought back this gem of a picture, which we LOVE!  There are more great photos and videos on Grandad's blog.

My kids had a great summer:  swim team, choir camp, and ballet camp in June, South America in July, and New Mexico in August.  I can't believe its over; school starts tomorrow.  Summer's over, but the heat goes on....

As we return to the school routine, hopefully I will get that post finished.