Busy Days at Work

Well I have had some really busy days at work...and still have two more to go...today is Sunday and that means pure chaos at the clinic!! I have seen some interesting cases though...another dog that ate a sewing needle....got that one out with endoscopy also. The other night had an old LARGE black lab come in collapsed, I look at gums - pale white - uh oh I already know what this dog has, palpate abdomen - huge fluid wave, dog is so obese and full of fluid that I can't really palpate anything in the abdomen, talk to owner about my fears of hemangiosarcoma in spleen, bleeding out, etc...we do ultrasound and find gigantic mass on spleen, wife says euthanasia but goes to get husband..who comes in like a pistol saying absolutely that euthanasia is not an option (this is two hours later and meanwhile dog has been bleeding out...)...SO I bolus liters of cystalloids, some colloids, and a unit of blood...knock him out...scrub...and $4500 dollars later head in to surgery at 11PM!!!....Getting through the layers of fat is challenging, finally able to see abdomen and blood starts pouring out as soon as I open the peritoneum...suction on....I locate spleen...gigantic nodular mass - about the size of a softball...it has little bleeds but not huge hemorrhage...hmmmm....go to look at liver...oh shoot...riddled with small masses and then some large nodular masses that are actively hemorrhaging....contact owner...they opt for euthanasia on the table...sad story...but unfortunately this is a bad disease and why a lot of times people don't go for surgery...especially since survival after is still only 5-9months. Had a case last night...8yo male neutered Bernese Mtn Dog...came in with all peripheral lymph nodes enlarged...uh oh...I already have a diagnosis in my mind before I aspirate and plop slide under microscope...yup...sheets of round cells...lymphoma...the story gets more sad...I tell the owner and he breaks down and bawls in the room...then says his wife's father just died of cancer, his father has it, his mother is in the ICU in New Mexico for something and he is going in for surgery on Thursday...WHAM!!!...I felt really small!!...but talked a lot with him, lymphoma fortunately is a cancer that does respond well to chemo and can go into remission...he is all for chemo...so we started him on prednisone...sent out the aspirates for professional pathological review...and he is coming in today to induce with chemo...I hope he responds!!! Had a really cool cat that ended up with an abdominal mass...sad...he is still alive though, doing great, eating as soon as I placed the nasogastric tube (of course - nothing like a therapeutic tube down your nose to make you decide now you want to start eating!! oh well...if he goes to surgery he will need the tube because for sure he won't eat afterwards!!). What else...millions of ultrasounds last night...a couple masses...a couple hyperchondriac owners...but hey...I always joke with the other docs...we are always like "I can't believe that owner is spending all this money when it is hopeless"....but at the end of the day...put apache, cosmo, or webster in that position and I would drop any amount of money even if it meant I got an extra 5 minutes to spend with them...because in those 5 minutes I could hug/kiss/tell them how much I have enjoyed them/thank them for being in my life...so I try to keep that in mind when I talk to owners who just are not ready to let go because in the end...is there ever gonna be a good time to let go?? The answer sadly is no....so we do what we can in the meantime...and when the end comes... cry and mourn but don't forget to smile for the good times too!!

Let it Snow...Let it Snow...Let it Snow...

We got another snow storm here last night...and it was pretty slow at the clinic as a result. I did see a couple cases...one I admitted was a referral from another veterinary clinic...8yo MN Rhodesian Ridgeback who presented to explosive bloody diarrhea. On PE he was severely dehydrated with tachy mucous membranes but nice and pink and normal capillary refill time (push on gums and count how long it takes for the pink color to return...normal is 1-2seconds...this can give an indication of perfusion...so if they are shocky and need fluids it would be prolonged)...his was normal...rectal revealed frank blood, he splinted on abdominal palpation (was extremely painful)..remainder of exam was WNL (within normal limits). Admitted him, ran coagulation times, CBC, electryolyes (rDVM had done a chemstry that was normal) - bloodwork came back fairly normal - except PCV/TS were elevated (54/8.0), he had a L shift (immature white blood cells high), and his cPLI (canine pancreatic lipase - test for pancreatitis) was abnormal...however pancreatitis was not the first thing on my list although it could definitely be a factor as well. I was thinking more HGE (hemorrhagic gastroenteritis) - this is basically a disease where the dogs are really dehydrated, they have elevated PCV/TS, and usually are having blow-out bloody diarrhea and sometimes vomiting as well. We did abdominal ultrasound and it showed gas in stomach and intestines and decreased motility but not real other abnormalities. So I started him on rehydration rate of fluids, metronidazole (anti-diarrheal antibiotic), unasyn (another antibiotic - because of the L shift), cisapride (for intestinal motility), and fentanyl CRI for pain control. Also placed a nasogastric tube and started trickle feed of Resorb for enteral nutrition (gut nutrients to keep it from sloughing even more...keeps gut cells happy!!). He has fecal cultures pending that I submitted to check for other fecal pathogens (salmonella, campylobacter, clostridia, shigella). We will see how he does...hopefully he does well. My second case was an old hunting lab who had pain somewhere that the owner couldn't fine where...PE was fairly normal, normal neurological examination, but severe pain on dorsoflexion and L lateral flexion of the neck. Sedated, did cervical radiographs, didn't see nothing, placed him on strict cage rest, no neck leads, tramadol, and rimadyl (NSAID). I think it is just muscle pain in him because neuro was normal and the owner mentioned that the shock collar he has on for the invisible fence was malfunctioning so I think the dog got repeatedly shocked and has muscle trauma due to that...poor dog!! My next case was a pitbull who came in for a red eye....now there are about 8 causes of red eye (glaucoma, scleritis, episcleritis, keratitis, conjunctivitis, trauma...)...So I do PE - aside from the R eye (OD), normal PE. I sedated dog and then did my fundic exam (to look at retina, optic nerve), this was normal. I then checked pressures (tonometry) and they were normal (13mmHg). I then stained the eye with FES and checked for a corneal ulcer - there was none. When I was examining the globe however, there was a lot of scleral hemorrhage and bruising on the globe - looks like a traumatic, blunt hit type injury. So I prescribe steroid drops for 3-5 days (because there is no ulcer) and then when I take dog out to owner he mentions that earlier he had to tackle the dog when they were walking so the eye was probably bumped at that time. Poor dog, but should heal up just fine. My last case was a 2yo MN orange (!!!!) cat who was straining in the litter box. He came back as a stat because of possible urinary obstruction...but I palpated bladder and it was very small, soft. So I talked to owners about different causes of FLUTD (feline lower urinary tract disease)...urethral obstruction (which he still could be in the early stages of), UTI, stones, idiopathic cystitis....discussed running bloodwork, urinary ultrasound, and urinalysis....owner agreed....everything came out fairly normal...did prescribe a couple days of pain meds and antibiotics in case of infection....but he probably is one of the idiopathic cystitis cats (meaning we don't know what causes it but something causes them to get bladder irritation and they end up with these straining episodes) Discussed management as being increased water consumption and pain medications....talked about switching diets to canned urinary diet because he did have crystals on the urinalysis. He went home...but he was a really cool cat...talked and loved to be held....And that was my night. Now I am heading back in for day 2/5. It is Friday so I am sure tonight will be busier as all the regular veterinary clinics transfer their disasters over to us for the weekend. But, I am happy because after this 5 day shift I am finally on the ICU shift for basically the rest of my time here....happy times coming off the floor..yay....actually get to manage cases!!!! Alright....I have to head out to work.

Tis the Season...

Ahh, it is that time of the year...when the snow comes and Santa's workshop is in full gear...and we get to put up pretty decorations all around the house. So I did some baking the other day on my time off - some pretzels with white chocolate and some chex mix - I still have to make my puppy chow and then decide on one cookie to make. And today, I went and bought myself a little tree and decorated my apartment...and made some egg nog coffee drink...mmmm! So, make sure to scroll down below because I have posted some pics of my decorations. And may I say that the kitties love this holiday as well...Webster and I were so excited setting up the tree....he helped so much....I put the tree up, he tried to knock it down...I put the bulbs on, he batted them to the ground...oh but he was just so happy to have a tree back again!!! So I am finally on a couple days off...2 and then Wed on call. Lets see, what did I work this past shifts? I worked Wed-Fri, Sun. Wed-Fri were l-o-n-g shifts of about 19hrs each!!! I had some very cool cases though. Had a neck abcess - huge about the size of a soccer ball--had to go in and open in up surgically - I cut into it with my scalpel and pus just started pouring out!!!! It was very awesome...yet grotesque at the same time!!! So I flushed that out and debrided the tissue inside the abcess pocket....very carefully as I was looking straight down at trachea, esophagus and two pulsating jugular veins...oh yeah...and I was all by myself...I have to say though that it was great!! Placed two penrose drains on each side of the neck (so that I could close the wound yet it would still be able to drain.). What else, last night I had a dog that swallowed 2 garland strings of popcorn and fruit loops...and the needles that were attached to them....oops and ouch!! So, I took an x-ray first and the two needles were sitting right in the stomach so we did endoscopy and pulled them out that way. The stomach was pretty ulcerated afterwards so he will go home on sucralfate and pepcid!! Saw a couple vomiting diarrhea cases of course....a couple had pancreatitis so admitted, fluids, pain meds, antibiotics, NG tube for feeding. One was a hemangiosarcoma (cancer in the spleen)...sad case...owners were totally not expecting that but luckily on my PE I had felt fluid in abdomen and a huge spleen and so had talked with them about that being a possibility...and unfortunately I was right! What else did I see?? We had a lot of stats....dying cats...2 we saved with CPR!!! One went on a ventilator and then came off and is still alive, the other we saved and brought back to life and then owners couldn't afford further care and so we had to euthanize....very sad after we worked so hard to bring it back to life and actually did it!!! Saw a big parrot with a bleeding tail blood feather...so I yanked it out....crisis averted!! Saw a torn toenail...sedated, yanked it off, bandaged it, dog went home....another life saved!!! Yes, ER is exciting and you get to see a lot and maybe I will miss it a tinge but on July 8, 2008 I do not think many tears will be falling...!!

Why I am Pursuing a Residency...

I feel like I should explain myself and my career goals...I think perhaps not everyone understands what exactly I am doing. I know there are people out there who think I am still in school...I am not...I have my license and I could go anywhere and work. What I have chosen to do is pursue further, higher training. I am in an internship now, yes, but this is still a job! I am working, getting paid, my patients are mine and I make the decisions on them. And after this year, yes I could just go work in a small vet clinic, but I do not want to do that kind of work. Vaccinations, broken toenails, spays, declaws are just not my life's goals...I want to specialize and so that is the reason for me pursuing a residency. It is still going to be a job...I will be working every day...it is just different kind of work, specialized...like when you go to the doctor for surgery you do not go to your regular practioner, or for GI issues they send you to the gastroenterologist...the same thing holds true for veterinary medicine. Human doctors have to go on and do internships and residencies as part of their training...veterinarians do not, but there are the select few of us who wish to do that and want to specialize in a certain aspect of veterinary medicine. That is me. I like internal medicine. What that means is that when you take your pet in to your local veterinarian and they diagnose it with thyroid disease or adrenal disease or it is losing weight and you can't figure out why or the treatment is not working and the pet is getting worse...they will refer you to someone like me...for further diagnostics, and treatments that are out of their capability both mentally and physically. Once I am done, I will never do vaccines or spay/neuters or broken toenails...I won't work in a small little practice with one vet and one technician...I hope to be in a specialty practice somewhere with other specialties like oncology, surgery, dermatoloy, exotics, pathology....why?...because I do not ever wish to do surgery or deal with dermatologic issues...and I never want to see rabbits/ferrets/birds/reptiles again...so you see...I have a special interest....internal medicine, and so that is why I wish to pursue higher training...so that I can be Board-certified in that specialty and deal with only internal medicine issues. If I went into regular practice I would be miserable...I would find it remedial and boring. So yes, this training is long and it may take me far away from family and friends....for a little while...but afterwards I will be happy with my career choice and I will be able to move anywhere and get a job...and then I can think about starting a family. I know it seems weird and people are skeptical about why I think I need to go all over the place and why can't I just get a job...but it doesn't work like that...not yet anyway... So, if you all care, here are the states I am applying to: Minnesota, North Carolina, Boston MA, California, Georgia, Texas, Tennessee, Michigan, Ohio, Alabama, Colorado, New York.,..in no particular order - I have not decided my rank order yet. So, I am really excited and I hope that I get a spot. This is a very competitive residency...there are hundreds of us applying for ONE SINGLE SPOT at a particular place!! Yes, that is crazy and I am scared that I will not get chosen...so I know that there are those who don't understand why I am going to be moving all over - but if you could just be happy for me and send up some prayers for me between now and March (when I find out)...I would appreciate it....I need your support now and throughout the training...even if that means I head somewhere else for 3 years...don't count me out of the family because at the end of it all hopefully my smiles will be well worth it.

I'm Betty Crocker!!

So I still have a lot of the apples left from home and I didn't want them to waste so I was tyring to think of things I could make with them that I will actually eat. I don't really eat pie or apple crisp...so I got out my cookbook and decided to make apple cinnamon muffins, from scratch -- the turned out quite good actually...I was pretty proud of myself. Yes as you can see...I lead a very exciting life outside of the clinic!!! Now I am just watching tv..the shoe scrubs...I never used to really watch the show but a friend from Vet school that I used to hang out with would watch it all the time and I sorta got hooked on the show. I heard on the news that it is supposed to snow on Thanksgiving...actually some accumulation possible...good - hopefully it will keep people away from the ER on Thanksgiving so that I get off early!!! Of course unless your pet is dying them come in for sure, but a torn toenail is probably not an emergency!!! Well, I am going to finish my glass of wine and head to bed because I am on call in a few hours. Smiles.

Back on the Triage floor...

God how much do I hate the triage floor!! Although...I did see some pretty interesting cases this past four days and it is true..winter does bring some relief. I saw a little dog the other day that had the clip from another dogs rabies tag pierced through his lower eyelid!! - yes and so his eye was wearing this other dogs collar - ouch!!! So I sedated him and threaded it back out, stained his eye - no corneal ulcer - woke him up, and sent him home with pain meds and antibiotics. Satsifying case I guess. I also saw a bird that had dipped its beak into nail polish and then was acting all drowsy and tipsy on its perch. That would be from the butyl alcohol in the product - causes drowsiness, seizures, pulmonary edema - bird was fine once at hospital and lungs sounded fine - sent him home for them to monitor him over the next 12 hours as it can take that long for the pulmonary edema to develop. Had a pitbull with a neck laceration due to being tied out on a cable. Anesthetized him and fixed it, had to be carefull of jugulars and trachea in that region but I think I did a good job. The gross thing about this case, while under, tape worms start coming out of his butt - so the tech started to pull them and she got a huge hand full that looked like spaghetti and would not come out so we had to cut them!!!! It was so gross!!!! Yeah- he got dewormer also. Ich!! What else did I see - urinary tract infections, broken toenail, hot spots, pesiticide ingestion, ... the list goes on, I forget as the days go on. Oh yeah - saw a very sad heart failure case, 10 yo dog, came in in respiratory distress, couging up bloody froth, mucous membranes blue - gave her injection of lasix, torb to calm her down, and nitro on her gums and placed her in oxygen. Talked to owners about this being heart failure as she has history of heart disease. Said we need to get her out of the episode of failure - if we do she has progosis for survival of 9-12 months, every episode after decreases about 5 months. Said to do that we may need to place her on ventilator - she needs CRI of heart meds, echo. Talked about the fact that if she ruptured one of her chordae tendinae (ligamentous part of heart valves) then there is really nothing we can do. Well, after crying for a long while and talking on the phone to her husband they decide they will euthanize and wife wants to sit with her while husband gets there. So I bring her back to ICU to the oxygen cage and let her sit there - meanwhile the dog has not improved and still has pink fluid dripping from it mouth and nose. I walk out to go grab the forms I need them to fill out and all of a sudden they are calling me back - the dog is now laying on its side in the oxygen cage, pink fluid just pouring out of its mouth and nose, struggling for each breath. I say we cannot wait for her husband we have to euthanize now - so we do and of course the owenr is just bawling, what a mess of a case!!!! Poor dog and poor owner. Ok, enough work talk. I am applying to 13 residency programs...13!!!! I hate this, I probably will spend all this time and money and not get a residency. I hope I do. I have the three clinicians from AEC writing me letters....I know they know a lot of people!! We will see.

Chinchilla??...what do I do with it?

Where to start...my past 4 days in the ICU were...interesting...and quite sad as well...the one day when I came in to take over there was the cutest 4yo white bulldog/boxer mix with one ear that just stood straight up on its own and the other that flopped over. He had previously had surgery at his vet to remove a very invasive mast cell tumor from his left hind limb...apparently they had to remove half of the cranial tibial leg muscle...so the dog had went home and then continued to bleed from the leg, went back to his vet who took one look and said yeah go to AEC. Let me tell you about the mast cell tumor...compare it to an anaphylactic shock reaction in humans severely allergic to bees/peanuts...and that is what this tumor does in the dog....and when you go in surgically and muck around...it releases all the histamines, sets off the SIRS (systemic inflammatory respons sydrome) and basically affects all aspects of the dogs body...we transfused the dog two times and he was still dripping blood from the leg...so I talked with the owners and we decided to take the dog back into surgery to see if there was a vessel that needed to be ligated...when placing the dog under anesthesia he stopped breathing, but we got him intubated and then things were ok....however I called owners at that time to touch base and let them know he wasn't doing well...I get off the phone and all of a sudden I hear "code to the surgery suite"...so I run in there and see one of the residents up on top of the surgery table doing chest compressions!!!...oh great!!!...he is not responding, I get to make the phone call and owners elect to stop CPR efforts...sad...meanwhile, the owners of my other pet in ICU are visiting...this is a dog with presumed pancreatitis who was just not responding to treatment...he was taken into surgery for biopsies and explore...and now was severely hypotensive and not responsive...I had him on a dopamine CRI and still could not get a blood pressure reading...owners had elected to euthanize finally after 8 days and $6000...and as I was getting the solution I hear once again..."code to icu"...it was him, trying to die before we euthanized...so I helped him out...it was a sad night. Then Bubba the chinchilla walked in the door at about 2AM...I didn't evenknow what a chinchilla was going to look like before I walked in the room...he was really...cute?...but sick, lethargic, not eating x 2wks...so I took him in the back and it turns out he has really bad teeth that are malaligned and have sharp points on them which are cutting into his cheeks...ouchy no wonder he doesn't want to eat...so I got him admitted and we gave him pain meds, sq fluids, syringe feedings...and he turned into a little piggy...eating everything we gave him!! The other night I had a cat come in that had been straining so the owners thought it was constipated and administered a fleet enema....NEVER DO THIS....fleet enemas are toxic to cats because they contain phosphates which cause hyperphosphatemia and then hypocalcemia in cats...end up with a cat with seizures, trembling, cardiac issues....so I ran bloodwork and no abnormalities and since it had been 6hrs since the enema was administered the cat was lucky and probably the owner grabbed the one enema with no phosphates..crisis averted...ok but why the straining? Took rads because owner convinced of constipation even though on rectal nothing was in colon...rads showed no stool at all in colon....but of course if you go looking you are going to find something...GI tract was suspiciously knot-looking...could have been because of the large amount of intra-abdominal fat or dehydration...but hey not constipated...so instructed owners to go to their vet in am to re-take rads...then I did a UA because I really think the cat had a urinary tract infection...so I put him on some antibiotics and we will see. Then I have 45minutes let on my shift and in walks a pyometra dog (uterine infection) I know before I even put my hands on the dog...took rads, didn't see anything, placed ultrasound probe on belly - yup two large fluid filled uterine horns....talking with owner about surgery...he wants to try antibiotics and I say she is very sick, likely already septic...it is either surgery or euthanasia...surprisingly...he signs the estimate for...surgery...its a go...I say she won't go until later in the morning becuase she needs to be more stable first...so I walk back to fill out her treatment sheets and low and behold she is laying on her side...won't get up....start fluids and blood pressure is....unreadable....great she is now in decomensated shock....so I start bolusing both HES and crystalloids...finally get her up to 110 blood pressure and heartrate down from 180 to 130....ok....also started her on pain meds and antibiotics...so then I transferred her to the next icu doctor and that was that....treat and street!!! Now I am sitting around in my apartment obviously not studying like I should be...trying to think about things to write in my letter of intent and trying to figure out what residency I want to rank...

I think there's something in her eye...

So I ended up getting called in last night around 8PM to help out on the floor because one of the other Dr's had to go help out the surgeon in surgery...didn't get out of there until 1am. Saw some cool cases though. One was a torn toenail - that's not so cool, just sedation, rip it off, and then bandage it. Easy. Ok, second case was a weak cat...breath smells like renal disease...I get him admitted, run some bloodwork, and surprise...acute renal failure just like the cat I talked about in the last blog...BUN 387, Creat >13.7, Phos >16.1. Ahh yes, same story different cat. Call owners and say we should place a central line, urinary catheter, do abdominal ultrasound, urinalysis plus culture - and increase estimate to 2500-3500. They seem a little taken aback by the price (who wouldn't be!!!!) so I say that we can also keep as we are, rehydrate him, recheck his blood values after he's hydrated, and see if he is responding...if he is, then we probably should go ahead and do the above, if he isn't he probably needs dialysis...either way, gives them time to think and also allows us to see if he is going to respond before they invest all that money. So they decide to do the latter....I wish I could have stayed to take care of him...that is the worst thing about the triage floor...it's just "surf and turf"...you stabilize it and then boot it to ICU for the doctor there to take care of...I really don't like that...I like seeing my cases through, making the decisions on what to do next...oh well, someday. So my last case then was a dog that was squinting a lot, her eye was watering....I suspected either an ulcer or a foreign body in the eye...so I sedate and take a look and yep...little sliver of wood stuck right in her cornea...so I give a little more sedation, numb the eye with drops, and removed the little stick...then sent her home with topical antibiotics and oral antibiotics...oh yeah, and a referral to see the ophthalmologist the next day...I am not taking that chance!!! So that was my on-call shift..got out of there at 1am. But hey at least I get an extra $50 for getting called in....whoopee!!!

Hard Lessons Learned

Hi...first have to apologize because my computer crashed last week and so the 'Geek Squad' has been fixing it for me and luckily it is back and functional and have not lost anything that was saved....which is awesome because my paper info was all on there, pictures (which are non-replaceable). So work has been..weird..messed up...so I've come up with some lessons that I have learned these past 4 days while I was working in the ICU (which I love by the way...reinforced how much I hate the triage floor!!!). LESSON #1 : Life IS hard - deal with it...and if you must quit...don't burn bridges!!! So, we are down one intern starting next Monday...yep she is actually throwing in the towel and quitting. To be fair, she does have a couple health problems she is dealing with, however for the most part the main reason is because this internship is hard as hell, it was never what she wanted...so it seems weird that she would take it in the first place...but also, people are mean to her at the clinic, I have noticed this and it makes me really mad...she is a good friend of mine and I hate that people are always talking so bad about her...I think they are realizing now that we are friends because they say a lot less around me now about her...which is good because I don't want to hear their mean comments anyhow. I WILL still stay friends with her because she is so nice and we have a fun time when we go out. She is staying in Milwaukee to work, her boyfriend is finishing vet school at UW. BUT...despite that...I am irritated becuase the schedule is out thru Feb...and now it needs to be re-done...what that means is the rest of us will lose days off and end up working more, more on-calls....that makes me really irritated!! The schedule I have now was going to be perfect for allowing me to travel to different places to interview for residencies...oh well though...life goes on... LESSON #2: Do NOT drink and drive with your dog!!! Yeah, this is a very sad story. On my Sat. night shift in ICU, around 2:30AM we got a call from the Milwaukee Police Dept. saying they were bringing a dog in that had been involved in a car accident...hmmm...it of course was called as a stat triage...it comes back on the stretcher and it is this big, beautiful brindled bull dog...with no pulses, no heart beat, not breathing...DOA. So, I go out to talk to the Police officer...apparantly when they arrived at the scene the dog was found pinned between the front seat and the dashboard...he was breathing at that time but had blood running from his mouth, he started agonal breathing on the way to AEC and was dead by the time they arrived here. The worst part was the it was a mom's dog and her son had been driving drunk...who knows why at 2AM with a dog in the car...and crashed into a light pole. So the son was in critical condition, they did not know if he would make it...and I had to call the mom and tell her her dog was dead. That was a sad phone call - one of the hardest I have ever made... The thing that makes me cry is that the dog was probably so happy to be going for a ride in the car...and then he died because his owner that he trusts to take care of him was driving drunk!! Bad decisions, hopefully if the son makes it this will wake him up a bit... Please...don't drive drunk with your pets, and if you take them in the care...seat belt them up because they are no different than people... LESSON #3: When you leave for vacation - Hug and Kiss your pets as if you will never see them again...because you might not!! Two really bad, sad cases I have now had of owners that left on vacation and returned to find their cats dying. One was the blocked cat I discussed in an earlier blog. The other,another cute little girl kitty who the pet-watcher described as hiding alot and so she never really saw the cat alot. When the owners returned, the cat was under the bed, severely dehydrated, not eating, laying on it's side. She brought it to her vet who did some preliminary bloodwork and found severe renal elevations and so it was transferred over to AEC. My ternmate admitted the case and I inherited the disaster later that night when I came on shift in the ICU. The cat had acute renal failure...was more than 10% dehydrated (this is raisin-like for those who don't know), and had renal BUN of 386 (normal is less than ~27), Creatinine of 14 (normal less than 2.0) and Phosphorus of 27!!! (yes I kid you not!!! normal is usu less than 4-5). Oh my god...wait...it gets worse. The sodium was 190 (normal is around 140-150), chloride was 170 (normal around 120), potassium was 5 (this is high end of normal). The cat was started on rehydration fluids to try to both rehydrate and also to flush out the toxic high levels described above. It gets worse...with sodium and chloride that high, this means the blood is hyperosmolar (think of it as really salty) - what this means is that the fluid in tissues is then going to tend to go into the blood to dilute it....this is especially bad in the brain...so what the brain does (because the brain is oh so smart and really only cares about its own survival) it creates substances that make it hyperosmolar as well so that is does not lose fluid and still can get the blood supply it needs. OK, go brain...however enter me with my fluids....with a cat like this I want to push as many fluids as I can obviously because I want to flush out the toxins...but now I can't because I am adding fluids which will dilute the blood (which on one hand is good) but for the brain...now it has produced these substances that will stick around and it is matching the blood, the fluids I add then will tend to leak out in to the brain causing cerebral edema...shoot!!!...so now I have this cat who desperately needs high rate fluids, but I have to push my fluids slow because you must only lower the sodium and chloride by so much per hour to avoid fluid in the brain. So, I push fluids over ten hours, normally I would push over 4-6hrs...and recheck bloodwork shows the values are not dropping, they are in fact rising. Now I know I am not pushing fluids as fast as I would like but this cat is still on about 4x maint which is a lot...and which should still be working to bring values down. So something else is going on. I reassess the cat and find that after being on fluids now for 7hrs, the bladder is no bigger then when I first met the cat, and it has not urinate...uh oh...I told you it gets worse. The cat is not making urine. So not only does it have acute renal failure, it has anuric acute renal failure....this is bad, it means the kidneys are not working at all. There are medications we can give to see if they cause the kidneys to produce urine (diuretics) however in this severely dehydrated cat, that is not a good option at this time. We do ultrasound and kidneys have some fluid around them and some minor abnormalities, but otherwise nothing huge...the rads also show nephroliths, but this could be an insignificant find. So, I get on the phone with the owners and say that the cat is most likely going to be one that needs dialysis - thousands of dollars - owners say they will not do that... I say then we at least need to place a central line (catheter) so we can monitor pressure which will allow us to push fluids faster, and she needs a urinary catheter in so that we can monitor if she is making urine. I give them a really poor prognosis, they fight over the phone with each other and then decided to try this first and see if we can get values down. So that gets placed and another 4 hours go by and I am in with the cat as the techs have just drawn blood...I notice cat is panting so I am listening to it and HR is 110 (normal for cat is 180) so I have techs hook up an ECG and there are huge abnormalities...before bloodwork is even back I know that values have increased again just from my PE and my ECG....I am suspecting that potassium is now at such dangerous levels that it is causing abnormalities in the heart....bloodwork comes back and confirms my fears so I get on the phone with the owners and they finally decide to euthanize, they get out of bed and come in. And, that was one of the saddest euthanasias I have ever done...the woman was just bawling and wouldn't stop...sad. OK - lessons done, dont think I learned any more. Work was super busy this weekend..and of course Saturday I had the pleasure of an extra hour at work because of the time change...I ended up doing 18hrs on both Saturday and Sunday...so needless to say I just came home and crawled into bed and slept half of my first day off...now today I am on call...I try to ignore the mess in my apartment when I get home..by mess I mean things knocked off of every table and counter, napkins shredded, mail shredded, any other paper shredded...this would be courtesy of my cats who do not appreciate it when I am gone for 18 hrs in a row and they are very 'vocal' about telling me this. If not for them however, coming home wouldn't be half as great. They love me ( or at least this is how I interpret it!!!)...it is like a huge train in the house from the minute I walk in the door...me and then my two little shadows following close behind...they sit on the edge of the tub while I shower, watch me brush me teeth...webster even sits on my lap while I go to the bathroom!!! and then we all go to bed...Webster gets the left armpit and Patches the right. The funny thing is Webster has always cuddled in my arm, underneath the blanket with his head on my pillow. Now however, patchie is doing the same thing.... and they love to sit on the couch...webster will help me send emails...throwing in an occasional line of jibberish which I don't understand but which I am sure he is trying to say something important.!! OK, well, sorry I have been a way for a while as I have not had my computer. Hope everything is going well for everyone...hopefully no one has any snow yet!!! Can't believe winter is so close....smiles

Pumpkin carving

Have some days off here...Friday night at the clinic...wasn't that bad...it got a little crazy busy for a couple hours, but then went ok, I was still out of there around 3:30a so not all that bad. I had a small little orange kitty with a really high fever (105F, normal is 99-102) and seemed really painful around the ventral neck region...hospitalized on fluids and pain meds because owners didn't want to spend a whole lot right away - blood work showed severe infection or inflammation going on somewhere...right before I was leaving for the night the owners called and said they had found a small glass dream catcher that had fallen out of the window - they were not sure when - so did not know if maybe he could have eaten some of it?? I discussed radiographs, other testing we could do - they wanted to see how fever responded overnight and then go on in the am if needed...I couldn't sleep that night though because kept thinking if he ate the glass what we should do - it made sense with him being so painful in his throat region - didn't see any cuts in the mouth though...should have placed him on sucralfate (a GI protectant - amy have coated the esophagus some and made him more comfortable)...it will be interesting to see what it is. So my cat from the other night with the fractured back went down to Madison for surgery!! Kinda cool. Tonight a bunch of us are getting together with the two externs we have ( a girl from Cornell and a guy from UW-madison) and we are carving pumpkins and then going out for some drinks...I think there is a lot of us who have the day off so it should be fun. This weekend Kevin was up and that was fun. We went to the movie 'Dan in Real Life'...it was funny and kinda sappy at the end...but funny for the most part, I recommend it. But he had to leave Sunday to get back to his life... Gets harder each time... miss him and Cosmo a lot...

Progress reports...

Back to work for the past three days, today is my fourth and last day and then I have 5 days off because I am switching over to the Thurs-Sun shift from here until Dec or later. Work has been ok, of course it's hard going back, but I guess it has been at least a little slower now that fall is coming...except at midnight - everyone still comes in - and last night we had 5 hit by car dogs in a row come in....someone was out hitting dogs!! Just kidding. What have I seen? I feel like I have been seeing a lot of older patients and doing a lot of euthanasias....and it's been making me really sad. I had one cat who an older man and his son brought in to euthanize because it was declining in health. The old man didn't want to be present so the son and I went into another room with the cat...just as I am euthanizing the son starts to say that this cat took care of their mother when she was dying and has been like his Dad's best friend since....and so that was really sad for me...and the man gave me a hug afterwards...weird. Then I had a younger girl my age come in with her big fat girl kitty - kinda like a patches - who was anemic and had been lethargic for the past couple days...turns out the cat had FeLV one of the feline leukemia viruses - she had been in a cat fight a year ago and probably got it then. Some cats can clear this virus, but in others it invades the bone marrow and starts causing the signs of anemia, low plateltes...which is what this unlucky cat had...unfortunately, it is a pretty grave prognosis - most will die within a couple months of complications due to the immunosuppression. So it was sad but we ended up euthanizing that one as well - as it was sitting and purring on her lap - that was hard for me because I just kept seeing patches. Last night I saw a cat who the owner lets outside at night for a little while, well she went missing last night and then the owner found her across the street in the park...when she got her home she noticed blood on her side and that she wasn't able to walk well in the hindlimbs. We clipped her up and she had some big puncture wounds (dog?? coyote??) so discussed surgical fix, owner just wanted to try antibiotics at home. I convinced for radiographs of the pelvis to make sure no fractures because cat was not wanting to use the back limbs which I thought was odd...results--spinal fracture (fracture of caudal endplate of L6) - ouch...oops...talk with owner and get cat admitted for a surgical consult tomorrow - don't know if will regain function of the hindlimbs, but owner will do anything for this cat so hopefully it gets some back...sad but cool case...so I will see when I go in today how she is doing. I saw a little black pug last night that had an ulcer on his eye that had possibly ruptured...it has mucous coming out of the middle of it...referred him to an ophthalmologist for further care and possible surgery on the eye....there is more to the story though, the rDVM stained the eye and found an ulcer on Tuesday and prescribed eye drops with steroids in them....if you learn one thing in vet school---it is you never give steroid drops with a corneal ulcer!!! Ooops...yeah this vet may have just caused the loss of that pug's eye...scarey!! So I placed him on Atropine drops to dilate the iris, triple antibiotic ointment in the eye, oral antibiotics, and oral NSAIDS....he also had uveitis as well...hopefully things go well. Had a 10yo seizuring dog last night in status epilepticus (meaning he was constantly seizing and would not stop)...finally had to sorta anesthetize him with propofol because he did not respond to the regular midazolam...long discussion with owners and finally decided on euthanasia because in an old dog with a first seizure it is always an underlying disease or brain tumor....not good, sad because owner had just had open heart surgery and so really wanted to be positive and give dog as best chance as possible...but they also were financially restricted. Other than that, I have seen a lot of cases but can't remember any other ones that stick out to me as being really interesting.

Oh sweet Vacation...

It has been so nice to be away from the clinic...honestly I have not thought much about it at all...it will be a sad day when I do have to go back. It has been so nice to get out of town...see different places...finally hang out with family. We went to Stewartville last weekend...it was nice...my brother Nick was back so it was good to see him even though I think he and I don't really talk all that much...he has always liked and gotten along with Jen better...that's ok...he's still my bro and it was good to see him. We had an early Thanksgiving since I will be saving the pets of Milwaukee on the actual date of Thanksgiving...oh well, what can I do...at least I partially have christmas and new year's eve off...I am on call (God they always find some way don't they!!!)...but hopefully it will be a slow enough time that I won't get called in...please people do something fun on the holiday and do not bring your pets to the hospital!!!...and don't let them eat wrapping paper and bows and candies either...that means potential surgery and Ang gets called in!! Heading to Chicago this weekend for the American College of Veterinary Surgeons Conference...yuck...but hey...I go where I am sent...and Chicago...could be fun eh?? Sitting with Cosmo now watchin' Grey's Anatomy...like that show...little bit too dramatic, but hey...that's entertainment. Sooo...residency applications are now open...gulp...going to apply all over... I know you all would like me to stick around here...but I don't know what it is but I just want to see different places you know...try different cities...far away seems so exotic...lonely I know....but we are young...time to live in different places before settling down ya know... so my places... east coast, west coast, southern coast, and minnesota, maybe Ohio only because I was so ;impressed with the degree of intelligence at that institution when I did my externship there...and I loved Columbus. I thought about Michigan but if it is on my list it will be at the bottom...can't possibly see myself as a Lions fan!!! Although the Red Wings are great!!! The Tigers...yuck!! And Iowa...well there is pretty much nothing else there...remeber driving through there with mom on the way back from....where were we coming back from mom"???...anyway...we were looking for food and practically starved ourselves because Iowa had nothing in it!!! God, where were we coming back from?? hmmm. Ok, well going to get going...I will write more about how the conference is...try to take some pics too...Smiles

Vacation Finally....

Thank-god I am on vacation until the middle of October...oh minus the on-call shift I have tomorrow that my supervisor stuck me with. These past four days on shift have been crazy and it's taken strength to get through them. Should I start with the bad? Ok, I was the noon to midnight person all 4 night and on one of the nights I was told to do another doctor's surgery so that he didn't have to stay any longer after his shift...and I had my own to do as well...and he got to come in 2 hours later for his shift...meanwhile I was there until 5:30AM...and had to be back the next day...only got 3 hours of sleep...he got about 6!!!! I hate favoritism....needless to say I was very mad that night. That was Sunday and we were so busy on Sunday that it wasn't even funny. Saw another hit by car dog, a little bulldog who had a choking episode because the owner pulled too hard on his leash to yank him up from a woodchip pile (this causes an instant increase in pressures and you end up with non-cardiogenic pulmonary edema = fluid in the lungs) and then you end up with a blue little bulldog who is vomiting and in respiratory distress. Put him in oxygen right away and ran some bloodwork and radiographs - classical pattern in the lungs of the alveolar-interstitial pattern in the caudodorsal lung fields. Talked with owner becuase usually these cases will clear with supportive care in 24hrs, however there is the chance they get worse and need to be placed on a ventilator. He was not willing to pay the full price so got him to at least hospitalize overnight with 12 hours of oxygen. Came in the next day and he was going home so I talked with the owner again...he was a really nice guy and really happy with what he feels like I did for the dog...which was only nasal oxygen for 12 hrs but hey if client is happy and dog is alive and well then I guess I have done my job. Saw Oscar the Lynx back again last night - so ended up his bladder ruptured and he had needed surgery and was in our ICU for days...he was back for a recheck ultrasound and bloodwork last night...he is mean though so we had to sedate him which took up 2 hours while we finally found something that would work for sedation without fully anesthetizing him. He is so cool to work with...when he is asleep of course. Never would have though I would have been treating a lynx!!! Cool part of the job. Our new intern finally started...we will see how she likes it. She too comes from Minnesota - we are all coming ot WI for some reason...she worked at that Banfield in Bloomington that I was supposed to work at that one summer!! Weird huh? Repaired a laceration on the foot of a dog that had jumped through the window to get at a chipmunk, the surgery I did for Jason was an abcess explore -- huge swellings on the side of this Rottweiler that luckily ended up to be mostly cellulitis so I just opened up one small abcess but it didn't track anywhere so flushed real well and closed it up. Then too a few punch biopsy of the cellulitis areas and stuck a few sutures in them. What else did I see...seizure dog that I kept over for watch last night...he is going to continue work-up with rDVM. Saw a couple cats with UTI's (just send home with pain meds and antibiotics) and one blocked cat (hospitalize with catheter). Saw a beagle yesterday with diarrhea and occasional vomiting, the guy had just moved up here from Florida and so didn't have a vet yet. The dog had lots of lipomas (fatty masses on skin) that he wanted to make sure were just that so I aspirated all of those and they were just fat. Also radiographed his left shoulder because he had constant lameness on it...it was DJD (arthritis)...this is a 50 pound beagle (they should be 20-25 pounds). So put him on some NSAIDS for that - not to start though until diarrhea and vomiting was cleared up for 2 weeks because explained they can cause GI ulcers. Took abdominal radiographs and not signs of obstruction or other problems. Ran a fecal which was normal. Ran bloodwork (lytes and chemistry) which were normal. So, gave some SQ fluids and sent him home on metronidazole (antibiotic) and dewormer course. The one thing that was off was he had a high PCV - 53%/TS - 7.4. I explained he might have the start of hemorrhagic gastroenteritis and with a high PCV we worry about sludging of the blood and clots...usually treatment is supportive with IV fluids...he didn't want to hospitalize so I just said to watch really close and if it continued to have him re-evaluated. He will probably do fine with the antibiotics but you never know. It is Chicago this weekend for me for the Surgery conference I have to go to, not so excited about that but we are going to spend some time in Chicago so it should be fun. Then I will be visiting some of the schools around the midwest here for interviews for residency positions...even though I don't really want to stick around here...for residencies can't be picky. Later...

And then there are those days...

I worked the 2p-2a shift yesterday, have today off, then am on again for 4 days straight before I get my big 13 day vacation...can't wait. Last night was hectic, and I made a lot of angels. My fist case was an 8yo male neutered Airedale Terrier who was laterally recumbent...at first I wondered if he was neurologic (aka - spinal disease) but after completing my neurological exam, he could stand and walk but was just really weak...so I was like uh oh...he was screaming metabolic disease. Plus heart rate was really high and I assumed that blood pressure was abnormal. He was also pretty painful in the abdomen. So, I talked with owner about running full bloodwork, getting set up with IV fluids, and doing abdominal radiographs. Got an estimate of $1000-1200 and got started. First blood pressure was high and heart rate was high so I bolused some fluids and rechecked, both still high so I bolused again...heart rate came down but blood pressure didn't. So I thought about it...hmmm...maybe painful...gave a fentanyl bolus and started a CRI of fentanyl...the result...normal heart rate and blood pressure - ok problem one solved. Next, the bloodwork comes back and dog is in acute renal failure...severe!!! So, I get set up with all the necessary meds to treat that...(fluids, phosphate binder, GI protectant)...meanwhile though dog is still laterally recumbant and very weak...odd...so I am thinking what has caused this renal failure...there is an infection (leptospirosis) that can cause this... and anti-freeze toxicity...even though owner states dog what not around any toxins and doesnt even have any anti-freeze herself, but being thorough I draw titers for the leptospirosis (to send out) and run an in-house ethylene glycol test (for anti-freeze). Meanwhile, we do the abdominal ultrasound,,,find not much...cysts in kidneys which is common for Airedale breed (they can get polycystic kidney disease)...so it is possible this dog had some underlying renal issues, but still what caused this acute episode. Then tech comes over and says ethylene glycol test is positive...so dog is dying of antifreeze toxicity. Great...call owner to discuss options which are peritoneal dialysis (placing tubes in abdomen and flushing to remove metabolites) and ethanol (yes we keep a bottle of vodka in the clinic for treatment!!!)...other treatment is just ethanol by itself without the dialysis...both options about 2-5000 uncomplicated...dog may not recover because is very sick at this point and may have renal failure that he cannot overcome...owner decided to euthanize...and then find out later she thinks one of the builders that worked on her house may have poisoned the dog because she had taken him to court...sad story. On to disaster #2 of the night. Enter Milo, a 2yo male neutered cat who was recumbent, not responsive, and gasping for breath. I mistakenly focus on the breathing, think the cat has an obstruction...it is the friends who are watching the cat for the owner who are on their honeymoon...great...so I have to call them to get ok to intubate cat and take over airway, talk about possible tracheostomy...surgery etc...they are pissed off about the estimate I give of 800-1000 but ok that. So, I go back, intubate which goes very easily and then happen to feel abdomen and bladder is rock hard...at that point I go sh--!!!! So here I have to go explain to owners that cat doesnt' have respiratory obstruction but instead is a blocked cat who is dying...but first hook up EKG...abnormal rhythm indicative of high potassium (which we see in blocked cats)...administer IV calcium gluconate, insulin, and dextrose and start a 1.25% dextrose drip in my fluids (all this helps to shift calcium intracellularly)...unblocked the cat...then the call to owners...of course they are confused because now I totally shifted focus of what is wrong with cat....basically thought boils down to fact that they are pissed off because the money is so high...becuase this cat just went up to a 2000-2500 cat....and they are on honeymoon and so worried because can't be here....so they say they need to talk about it and not to do anything more...so I said we would just do supportive care for now...then I get a call from another sister who yells at me over the phone about cost and ruining their honeymoon and that she should have been called first...I explain legally I have to contact owners...tell her she needs to talk with them...I think I calmed her down but she made me really mad!!! Meanwhile the whole family proceeds to call in and tell me what they think about the price and the way case is being handled and how the owners honeymoon is ruined...I feel like saying I don't give a shi-...the cat is alive, I have saved it,,,now what do you want me to do from here...they ask if it hadn't been brought in how long it would have survived....I said maybe one more hour...but cat was dying....well basically it was back and forth all night and finally, sadly they decided to euthanize him...the sister came in for it (the one who yelled at me earlier) and she took one look at the cat who was still lateral and not responsive at this time and says..'oh my god he is sick..proceeds to call owner on phone and say how sick he is'...at this point I am biting back my I Told You So....and just nod and say yes he is...of course they want to save cat but I can't give prognosis until we re-check bloodwork and see...I have never seen renal values as high as they were in this cat (BUN-498 normal is 7-27) (phos 16.1)(K 9.8!!!!!!!) and still having abnormal rhythm. I would really have liked to try and see how the cat did...cats are pretty amazing....but... I understand it is a lot of money for a cat...so we euthanized...and as I am giving the injection sister says to me...he proposed with this cat, with ring around its neck...final knife twist in my heart...now I kinda understand the family's anger...but damn (sorry for the language) the cat was dying and I saved it, I am sorry this clinic is so expensive...not my fault. So, those were my two angels I made last night. Then of couse around 11pm when it is just me on the floor, the whole city of Milwaukee decides to bring in their sick pets...and as always no one has any money so it is basically a lot of time spent giving sq fluids and dispensing pain meds or antibiotics or giving anti-emetic shots...but hey...since I euthanized all my patients...I had no inpatients...second time this internship...got out of there around 4:30pm by time I finished with all outpatients because I stayed and took a few extra cases after my shift to helo out...I have to stop being so nice...but oh well I figure I am learning at least and it is all over in July so do it while I can...Well, would love to write more but time to head in to rounds...even on my day off cannot get away from that place...

And then the job gets interesting...

It is definitely slowing down at the AEC with the fall and (yikes) winter months approaching...at least during weekdays...weekends can still be crazy...expecially between midnight - 3am ... why are people up at that time staring at their pet??? Stop...go to bed!!!! So I have spent the last 4 days in ICU, but that means I still end up as the primary doctor on the floor from 1a-4a...and let me tell you that sometimes that is when the crazies of Milwaukee come out!!! Sheesh... Last night saw a cat that was in shock, not responsive, owner had not even any money for an exam but they dinked around for an hour and finally we euthanized the cat after they fought with me and thought that sending it home with SQ fluids and antibiotics would cure it....the cat was lasterally recumbant, not responsive, HR of 90bpm (normal is 180) , blood pressure so low it wouldn't read, temperature 93 (normal is 100), respiration about 5 breaths per minute....cat was dying and I actually had to be mean and say I would not administer SQ fluids and send home because the cat was going to die...so I might have a complaint brought against me for this one but the cat was dying before our eyes...they darn thing almost died before I euthanized it... Next up...Lynx named Oliver with a urinary blockage!!! Cool pics below...knocked out...took rads...stones..needs surgery...owners took home because we cant really keep one here....see below for pics....I also emailed them to some of ya... It has been nice to be in ICU for the past 4 days because I have been taking care of some patients for 4 days in a row...it is nice...you start to know them...they grow in your heart...and you really get to take a huge part in their care...you are their primary doctor...you make all the decisions about their treatment...and so when they start to circle the drain, or the owners can't go on...it is really hard...Let's see, if it weren't for my two kitties and the fact that I live in a small one bedroom apartment...and the fact that I have no money... I would probably be the proud owner of 6-7 very sick animals that were about to die...as it was, they were euthanized...some for the best, some because owners just couldn't go on anymore - financially or emotionally. But, I did have some really great cases that I sent home...one was a big black cat named Bob who came in dead, CPR was started and he was brought back to life, he had a urinary blockage and that is why he arrested, his bloodwork was horrible when he first came in - renal values through the roof - electrolytes at unreadable levels...well he got unblocked, placed indwelling catheter, started on fluids and other meds...I met him about day 2 or 3, he was blind at that time (from oxygen deprevation during his arrest phase)...throughout that first night on my shift I noticed him startig to gain his sight back-he was responding to shadows and lights-pupils were responding-dazzle intact...continued supportive care and bloodwork gradually normalized...he did spike a fever because he catheter cut-down sites becaome infected so I started antibiotics and daily wound care...had him all four days and finally sent him home last night as a perfectly normal cat....I loved bob...big beautiful long haired black cat...the only set back...once he gained back sight he had to be sedated to even touch him...guess he was pissed off that we saved his life!!!! Owners were very grateful...Bob definitely had an angel on his shoulder...and I think he used up about 8 lives.... Next was a big old Rottweiller...Bear...nice at first then became so mean couldn't touch him...he had immune mediated hemolytic anemia and thrombocytopenia...came in with a PCV of 19% (normal is >30%), white mucous membranes, icterus, and platelets of 50,000 (normalis > 200,000)...ouch!! So, started on prednisone and azathioprine (steroids for tx of immune disease), doxycycline (antibiotic because some infectious tick-borne diseases can cause this and so we treat pre-emptively for it), low dose aspirin (to decrease risk of clot formation), and a bunch of GI protectants (because for some reason rDVM had placed this sick not eating dog on non-steroidal anti-inflammatory drugs....and now we had him on steroids....huge risk for GI ulcers)...then it was just monitoring him in case he needed transfusion..a lot of times they do...he is lucky and never did, his PCV remained 19-20% the entire time despite being on fluids. I monitored his platelets daily though and they fell to 15,000 -- yikes and poor prognosis -- so I stopped aspirin for a couple days so he didn't bleed...gradually then platelets started to increase, probably as the steroids started to work..so he went back on aspirin and eventually went home...still very sick and poor prognosis but from here on out it is just supportive care and frequent monitoring of blood values...he will either continue to respond well to the steroids or he will not...only time will tell... My favorite patient...a large 17 pound orange cat named...Pumpkin!!! Inside/outside cat, owners found under a tree with blood running from nose/mouth/eyes, unable to walk...came in in respiratory distress, was treated as head trauma case, gave mannitol and he was a lot more alert and able to function, still not able to walk (manitol is an osmotic diuretic so it pulls water out of the brain (helps with cerebral edema) and also it scavenges for free-radicals so helps in inflammation as well)...I met cat and he was laying on side in o2 cage...his lungs and heart sounded good and he seemed to be breathing well, his mouth was open but I felt it was more from pain than respiratory distress so I had them check a pulse ox (checks how well he is oxygenating) it was 98% so I moved him out of oxygen cage. He was extremely painful over his lumbar spine and would not even allow palpation of the hips. He had a huge fat, black and blue chin, lips, tongue and fractured tooth but luckily no jaw fractures. He also had a huge bruise covering his entire caudal abdomen - I was worried he had been run over and was worried about both pelvic trauma and vertebral fractures...he was urinating which is good (less chance then that bladder was ruptured)...I called owners and discussed radiographs of spine/pelvis and abdominal ultrasound...they agreed...I took them and.....this cat has an angel as well because not a single fracture, not a single abnormality on ultrasound!!!! So, he had been a low dose fentanyl cri for pain, I increased the rate and this made him for comfortable. I started to have them hand feed him and he actually was eating well. He seemed a little mentally dull so I administered a dose of lasix and another dose of mannitol in case of cerebral edema...didn't really change anything so I think he was just painful...He still wasn't getting up. The next day, he was feeling a lot better and towards the end of the night had us all in the ICU cheering as he slowly got up and went into his litter box on his own to urinate!!!!! He was so painful but still doing it...and last night he continued this...was actually getting up and moving around, very very slowly and crying while doing it because it hurt so bad, but he was up...so I transitioned him from IV fentanyl to a fentanyl transdermal patch and he will go home tonight!!!! I am so happy for him,,,he is one lucky cat!!! I still think he got run over completely but someone his angel protected him...He may never walk normally because there still could be some nerve damage, but he will at least walk!! Yay pumpkin... Had a cat come in with a fever...another outside cat...had fight wounds all over it...and one really nasty puncture wound/infected by shoulder...placed on IV antibiotics, fluids, abdominal ultrasound and radiographs normal...did also have weakness in hindlimbs...set him up to get knocked out daily for wound care (because he was a pistol!!)...gradually improved and was set to go home today!! Had a little dog last night with very low proteins and bloody diarrhea and vomiting...abdominal ultrasound found come enlarged lymph nodes but nothing else...three causes of hypoproteinemia are renal loss, GI loss, and liver disease...sent out biles acids (to test liver function), did urinalysis and sent out a urine protein:creatinine ratio (to test for renal protein loss)...and otherwise supportive care, tests are still pending...likely he has GI losses and will need some intestinal biopsies, but time will tell... One of the residents last night saw an egg bound bird...he lubed up the egg and the bird laid it and then proceeded to immediately fall over dead!!! I hate working with birds...stress just always kills them....it sucks and is so not gratifying!!! Got my paper proposal turned in...renal failure in cats....can't wait....how lucky for me to get my most favorite topic!!!! We will see if it gets approved...Now I am on my days off...go on call here in a couple hours for the next 24 hrs....but it is still nice to have some days off... Funny thing happened that I want to share,,,me and my internmate Katie were working the other night..and most of our residents and the cheifs are at the IVECCS conference so our one senior clinician who just took the boards was on with us....well a bunch of the residents previous and some of those who had been here before must have hooked up at the conference and decided to call AEC and talk....me and Katie are sitting there and she says..."that is so pathetic, who drunk dials their work!!!" and we were cracking up with laughter....then all of a sudden I'm like..."oh no, maybe it is because after three years of this schedule at AEC...work is all they have!!"...that is so sad.... god I hope I never have to drunk dial my work...please let me have a life outside of it all......smiles ;)

Surgery

So I got called in for the first time on my on-call shift Saturday...at 5am for a surgery because a dog ate the carpet out of its kennel and now was obstructed. So, had to go in and do that surgery...pulled carpet from the stomach (gastrotomy) and then two sites in the intestines (enterotomy)...went well...I was a little disappointed about being woken up so early, but then the surgery was actually fun to do so I guess it ended up not to be so bad...and then I didn't get called in again which was nice. So I may indeed have a peeping Tom...we thought we saw someone on my porch the other night as we were going to bed...I hope we were just seeing things because I just do not want to have to deal with that...hopefully it was just shadows of the trees...guess I am going to have to leave my lights on when I am away from now on and the TV on. Stupid freaks in life....get a life!!! Finally out of the city of Milwaukee which is nice...not heading back until Tuesday or Wednesday. Then I just have a couple weeks and then I have my 13 days off of vacation the second week of October which will be a nice break...am definitely heading out of town then...going to Chicago for the conference and hopefully to hang for a little bit and then hopefully Minnesota for a while as well...really excited about that...! Fall is coming, it is nice...all the pumpkins out waiting to be carved...think I am going to start buying some just for the seeds....yummmm I love the roasted pumpkin seeds...those are the best....maybe I will do that here on my few days off... How 'bout those Packers...especially Favre...settin' records...the Vikes...well we won't talk about that right now...Had some beers and watched the games...it was fun... Ok, well it is getting late and I think we are going to head off to bed here...long day...we woke up early to leave Milwaukee...Brought the kitties too so they are all freaked out about being in a new place again!!! It is funny because they stick so close to me because we are all used to being so close in my little apartment...poor webster...slammed on the breaks on the drive and his carrier fell off the seat and he went head first into the floor boards....no wonder that cat hates to travel!!!...and it makes me feel so bad every time... this is the second time his carrier has fell....luckily for me he doesn't get hurt!! OK...Smiles.. ;o)

Journal Club....done

Finally...my last shift for 5 days unless I get called in on my on-call day Saturday. Journal club came and went today...actually went ok, think I got nervous for no reason...Elke seemed pleased with how I did so that is good...here was the title of my article "Cardiac Filling Pressure are not Appropriate to Predict Hemodynamic Response to Volume Challege"...yeah, exactly what I thought....????what???? Tonight was a slower night...did not admit any inpatients - saw only patients that I sent home. Had a laceration repair...the owner had been cutting mats out of the fur of her cat and then she accidently cut the cat's skin...ouch...so we fixed 'er up...it gets a little more complicated though...she bit one of our technicians...not current on rabies...so I had to contact police dept and they sent over two officers to file a report..cat now has to be quarantined at home for 10 days. Say another dog had beenbit by the neighbor dog...deep puncture wounds all over body...just cleaned them because she wanted to have them repaired at rDVM tomorrow. Saw a ear infection at 12:45am...why are you up at that time paying attention to your dog's ears? So they paid a large amount of money just for that...but whatever. Saw a little kitten that was flat out...smelled like she was rotting from the inside out...huge swelling in caudal abdomen that I think was a hernia but not sure...she was euthanized and owner did not want to do a necropsy so not really sure what that was...tried to aspirate it and just got air. Well, I am tired and so going to head to bed...it is late or early depending on how you look at it.

STRESS!!

So it is a little stressfull working on the floor and having no time and trying to prepare for my journal club...it is tomorrow...I will let you know how it goes. At least I then have 5 days off in a row that I am really looking forward to. Work has been slow up until about 7pm and then we been getting slammed...last night we were really busy...saw once again some vomiting animals, admitted just one little dog who had been vomiting and his electrolytes were very off so he may have something else going on...radiographs didn't show a huge abnormality, but he may get a contrast series done today to make sure GI is moving as it should or an abdominal ultrasound. I will see when I go in today. Saw a vomiting cat who was really mean!!! So had to knock her out to draw blood and take radiographs,,,didn't find much on rads or bloodwork so owners just took her home with some supportive care and monitoring...they may be back. Saw a female cat who was straining to urinate...bladder was not huge...can see this in female cats with urinary tract infections, but also cannot rule out a stone or tumor...owners didn't want to do ultrasound or rads to look for anything else so just ran some bloodwork to make sure her values were ok, a urinalysis - which indicated possible infection (lots of white blood cells in there which is not normal) - so they are going to try antibiotics and some pain meds and if she continues to strain I said we will have to prob. do the ultrasound to look for another cause. Saw a couple lame dogs, but no one really wanted to do anything,,,the one just wanted pain meds because she had an appointment with her vet today and felt dog just needed some comfort overnight...he had some shifting leg lameness, some joint effusion--most likely either infection in joints, lyme disease (characteristic is shifting leg lameness), or some immune-mediated polyarthropathy (joint disease - treated with steroids)...but I guess rDVM gets that one, oh well, would have been cool to tap some joints and see what it is...also to take rads of all joints as well to evaluate them...maybe next time. Well, I can't write much...have to work more on my articles. I will write more after my shift tomorrow and let ya know how my presentation went.

Ahh some days off...

Finally some days off, although they will not be nice and relaxing as usual because I have this stupid journal club artivle to work on and then my paper as well...stress...does it really ever end? Who are these happy non-stressful people? I would like to hurt them!!!! Hee hee - just kidding. Well, I was there at the clinic until 6am this morning...it was slow in the early day and then we got slammed later at night... I admitted a Goose!!! I know I think crazy as well,,,a pet 25yr old goose...and yes...the owner was very crazy...poor goose is "circling the drain" (close to death in ER terms!!!)...very lethargic, maggots in the hind end, increased respiratory effort with horrible sounding lungs and mucoid nasal discharge, history of elevated liver enzymes, not eating, random bleeding from the eye....ok can I tie all this together?...well, if has liver disease could be slowly dying and could explain the other illness, could have cancer of liver and spread to lungs, could have fungal infection (aspergillosis is common in birds and can cause a multitude of systemic signs all seen in this bird...hmmmm)...the bleeding in the eye? I have no clue and honestly that is not killing the bird so at 4am I really did not try to figure it out...started IV fluids, antibiotics (enrofloxacin/baytril), antifungal(itraconazole), and gavage feedings...also iced lines because temp was crazy high at 106.8f(normal high in birds is 105...i think). But, goose looks like it is trying to die...will it survive...most likely not, but we have been surprised in the past...and let me just say one thing...an owner kissing a goose should have been the first indication that this case was going to be crazy...she wasted 3 hours of my time because she couldn't make a decision... I then had a really cool orange cat that was fighting with his buddy cat and now was sitting with his tongue hanging out of mouth, not wanting to move jaw...I sedated to look but already had my suspicion which was confirmed...fracture of the mandibular symphysis (joint in your chin between the two side of lower jaw...ouchy!!! Needs to be fixed with a wire...very easy procedure, but owner young and not much money so I hospitalized overnight and he was going to call his vet this morning and see if they could fix for cheaper because cat also has teeth rotting out of head that need to be removed and since his is 11years old I recommended doing it all under one anesthesia if possible. Saw a little puppy that was stepped on...luckily no broken bones...sent home with rest and pain meds. Saw a blocked cat that owners had no money so me and the extern did an outpatient unblock and sent home...probably will re-block and warned owners of that but they were happy for the time being. What else...?? Euthanized a couple,....of course that happens nightly...old dogs...with cancer or neurological disease...ok..honestly I can't think of anything else I saw right now. I have to go to read through my articles because we are meeting today at 3pm to go through them...it is so hard because I have only had two hours of sleep today because of course being on shift all night doesn't allow me any chance to read my article so I had to wake up early today and read through stuff and study...not cool...smiling though....really really really trying hard to keep smiling through it all...

One more Day

One more day of shift...then it's off for 3 days...can't wait. Has been a little hectic this week...had some doozy cases. One was a very serious dog that was referred over from rDVM because of anemia and weakness, hadn't eaten in about 3 days, not drinking, very weak and lethargic. I did full bloodwork, thoracic radiographs, abdominal ultrasound, and prepped them for possible blood transfusion. Thoracic radiographs didn't show that much, small heart likely due to hypovolemia (shock condition); abdominal ultrasound showed weird changes in liver, spleen, pancreas that none of the docs could explain; bloodwork--disaster: anemia, severe metabolic acidosis (almost inconsistent with life), and liver enzymes so high they were unreadable. So when the dog first came in, because it was a cocker spaniel I assumed likely immune-mediated hemolytic anemia (IMHA) because the breed is poster child for it. However, the severe metabolic acidosis and liver enzymes just didn't fit. So, talked with owner again about any possible chance of liver toxins and they say no chance at all. Other abnormalities was the dog was severely hypoglycemic (this can happen with liver failure, sepsis)...so then is dog septic (meaning does he have infection through bloodstream, are we missing a huge nidus of infection somewhere?)??? In meantime, dog blew 2 catheters so had to place a central line in the jugular vein, started the blood transfusion, high fluids, glucose at constant rate infusion, antibiotics in case of infection, steroids for immune mediated disease...repeated bloodwork and values had improved...however dog still looking horrible...continued supportive care but owners decided to euthanize the next afternoon because dog not improving clinically and money had to have been through the roof with all we were doing. Unblocked an orange male kitty last night that had a urethral obstruction...then he was wigging out on his opiods so I had to reverse him from those.,...he was rolling around the cage and likely seeing pink elephants...but reversal worked well and kitty doing well. Had dog with ear infection last night, dog that ate burrs and was hacking (offered to scope the dog, but owner wanted to try medical support at first so placed on pain meds and some sucralfate to coat esophagus...burr could still be stuck, but if it gets into stomach dog should be fine); saw a rabbit (severely dehydrated, not eating, not defecating, hypothermic...admitted, gave pain meds and some sedation, went to take radiographs and rabbit began agonal breathing and died on the table....she was very sick and luckily I had warned owner that this may happen as bunny's like to circle the drain when they are in the hospital). So, we will see what cases I come up with tonight. I am all stressed out because I have this journal club to do next week...the articles my senior clinician came up with are way over my head so I have to study in order to study the articles!!!! Crazy...and then there is my paper...that needs to be written yet too...so I have a lot of work to get done this weekend. I am excited about the weekend though because Kevin is going to come up and visit...it's nice to see him as we hardly ever get to see each other much anymore. And he is going to stay all weekend I believe he is taking off work on Friday to visit...he has a lot of work to do with his class as well...for those who don't know he is in a Master of Biotechnology program--he absolutely loves it...but lots of work on top of his work at Covance...so we are going to hang out at some of the little cafe's around Milwaukee and do some studying this weekend... I am so lonely here that I am really looking forward to having a buddy... I really miss having someone to hang with, although I am becoming more independent which is a good thing. Kitties are doing well, they are zonked in the sunlight right now... they are waiting for me to have days off as well... it is so hard sleeping at night because they just fight over who gets to sleep with me... and now that it's getting chilly at night they want to snuggle down in the covers...becuase you know I don't turn my heat on...learned that from Dad!!...especially since I have to pay for it. Fall is coming, football season--yay!! Although it will come and go without me really noticing it--sorta like summer, I can't believe it is already almost over. And it is getting near that time when I have to start looking at where I want to do residency...right now...Minnesota, East Coast, California are in my mind....we will see though, life sometimes has a way of deciding for you...try to plan and you just end up disappointed...go with the flow, take the hits, get right back up, dust yourself off, and keep trekin' and you will find that it really isn't that bad and you will start to find smiles around you....the worst thing in life is not living it...the others are just bumps in the road meant to wake you up and alert you to things that need to be changed in your life....breath in life around you, open your eyes, watch the birds, catch a sunset or sunrise, listen to nature, dance in the rain.....and always always always go to bed smiling over what you have experienced in that day....THAT is what makes all the difference...

Gotta love the days off...

Ok, I am finally on my days off...I had 5 of the worst days on shift ever...bad in terms of sleep is what I basically mean. Labor day...so busy that I just about walked out of the clinic and quit...I can't believe working conditions such as what I am in exist!! For future interns...I hope this clinic ups their intern numbers and stocks more interns per shift or makes the shifts shorter because this is crazy!! The last two days actually were scarily not busy, but I was so tired from the beginning of the week that it didn't really matter! I got a call back from the officer of the poilce dog that I surgerized and fixed the open joints and torn tendons...he wanted to submit the cultures I had taken...which is a good choice because we want to know if there is infection in the joint and if there is...it needs to be treat quickly because otherwise it won't just be that the dog won't work again....he may not ever walk again. But, I was happy to hear that Bosco was doing well, the officer said it was hard to keep him quiet. I asked if he had had the bandages changed like I had asked and he said he took to his vet and they changed them and said things looked great, incisions intact and minimal swelling....so that made me happy...I did good job!!! Yay me... I had another really sick dog come in, a large 144 pound Rottweiler named 'Bear'...luckily a big loveable intact male rottweiler. Peeing pure blood, anemic and severely thrombocytopenic (low plateletes), so that explains the hematuria (bloody urine)...can't clot, losing blood, ecchymosis as well (bruising of skin) due to bleeding. So, did abdominal ultrasound and saw odd looking spleen but can't aspirate it because dog has no platelets and will surely bleed to death. Let me give you an idea of how low the platelets are...normally should be greater than 200,000...this dog had 3000!!!! Yeah that'l make you bleed. He was also very anemic (normal is 30-40%, he was 16%)...so I gave him a blood transfusion and brought it up to 24% which is actually quite good...the amount of blood I gave him should have brought it up to only 19% so that means he is making some red blood cells on his own. So, he stayed in hospital on doxycycline (because infectious causes like tick born diseases, erhlichia, lyme,,,all can cause this and they are treatable with that antibiotic). Also started on prednisone and azathioprine (steroids in case this is an immune-mediated cause)...last I checked he still had no platelets but was doing clinically very well. The dog was never down and out like he should have been with blood values such as his...so it may have been a more chronic condition and his body adapted. Got a very sick renal failure dog in just the other night...very weak, pale...renal values through the roof!! This dog was a 14.5yo golden retriever...woman not really into heroics in saving dog, but I convinced her to do ultrasound and bloodwork and fluids to at least see what happens with the renal values, I said if they don't budge after 24 hours that gives us a more prognostic indicator (poor) and we can make decisions then...this dog is her life and if it was just simple renal failure, sometimes all they need is fluids and they can then bounce back...IF that was all it was, his story gets more complicated. He was diagnosed with renal failure in may and has been slowly declining since then...never was startedeven on subcutaneous fluids at home...hmmm..anyhow, dog stopped eating a couple days ago, woman thought it was maybe his arthritis, called her veterinarian (who keep in mind made the diagnosis of renal failure) who went ahead and placed the dog on Rimadyl (a non-steroidal that causes renal toxicity and should not be prescribed if the dog had renal issues)...it gets worse...dog hasn't been eating and woman has been giving this med for 5 days...did I mention this drug can also cause GI ulcerations? Ok, so far dog has not had any GI signs according to the owner. So, I get him all set up with fluids, phosphate binders, GI protecants, and hetastarch fluids (because he has low albumin and is in a possible DIC risk)... I also place a nasogastric tube for feeding purposes...his ultrasound shows nastiness in spleen and possible pancreatitis, owner doesn't want to aspirate it because she wants to wait and see if he will respond to fluids first, I say no problem we can always aspirate another day...doing well, then around 2am dog begans to breath very hard and with increased effort, I listen to lungs and hear occasional crackles but really nothing worse then when I originially ausculted...but contact owner and suggest we run thoracic radiographs and re-run some of the electroyte bloodwork(because this can cause increase in respiration also)...at this same time, dog breaks with blow-out pure bloody diarrhea...my heart sinks at this point because I think I know what is happening but I wait...radiographs are fine...bloodwork...worsening of values despite fluids ...hypoglycemia ...severe left shift (high WBC count indicative of infection)...clotting time prolonged...my fears are confirmed...dog is septic (because of the low glucose and hig WBC) and possibly going into DIC (disseminated intravascular coagulation - where he will bleed from every suface of his body while at the same time throwing clots all over....grave prognosis...horrible to try to treat)..I call owner to say we either go all out and hunt for source of infection, start on dextrose, and start treating...we are looking at thousands of dollars.....or we euthanize...owner chooses euthanasia which is not a bad choice as I fear we would have spent a considerable amount of her money and still sent her home with ashes. IT was very sad though...this dog was her life...but a very interesting case to treat. Had another little dog in for ultrasound, we aspirated the spleen and probably has either lymphoma or histiocytic sarcoma (another bad cancer)...only way to determine which is to do a bone marrow biopsy....owners consent and I got to do my first bone marrow biopsy...that was really cool. My other patient was an olde little painful toy poodle with probably chronic pancreatitis but also back pain. Treated her por the pancreatitis...IV fluids, nasogastric tube with liquid feedings, pain medications, GI protectants...if she starts eating and is not vomiting then plan to feed her per os (via mouth)....then send her home...recommend work-up of the spine then because she had severe changes on radiographs suggestive of disk disease. Saw a cat with a huge cat fight bite wound and abcess...owners just chose antibiotics and planned to take to reg vet for further opening up of the wound and flushing....cat will probably slough all it's skin off the back...hopefully does ok though. So those were my cases. I saw a ton more but those are the ones I remember. I talked to my friend Sandy the other day from vet school...she is in an internship in Georgia...said she hates it too!!! However she has day hours and goes in at 6am and it done by 3pm...how nice would that be!! I have been thinking more about the residency program and I think I am going to apply, but for an internal medicine residency, not emergency and critical care...can't handle these hours for another 3 years...nor do I like surgery so I want to get as far away from that as possible. Ok, well I need to work on my paper these days off...additionally I am due to run journal club in a week or two so I need to look for articles to teach the group....can you believe that non-sense? What am I going to teach the residents? This is a crazy thing!! My paper though, excited about that because it is on renal disease and that is my favorite thing...plus now I know I need to write it and get published to get my certificate and get into residency. Hope all is well with you. Check out below I added some new pics. Went out with my internmate Rachel and Andrea the vet from Italy last weekend...also finally used my grill!!

I'm back

Sorry I have not written in a while, have been really busy with work...long shifts...home just to sleep and then back to work as soon as I wake up the next day. I am on a string of 5 days on this week and it has been really busy and I am really tired and I still have two days to go. And the holiday weekend when no other vets were open...we got killed with cases!!! It was so busy on Monday night!!! Oh my god...and then of course at around 11:30pm when I am almost off and suppposed to be off the floor by this time...in walks a stat...a big old police dog German Shepherd bleeding profusely from both front limbs...had been working in the field and ran thru barbed wire and opened up both his carpal joints (wrists)...so of course, didn't start that surgery until 1am (keep in mind my shift was over at 12a)...Finished at 3:30am...then still had 5 inpatient records to type up....got out at 8am home to sleep for 2 hours and then back in again at noon yesterday...I was tired!!! I hate the hours...hate how busy it is sometimes!! Can't wait for my next set of days off here...Fri, Sat, Sun...So the surgery was cool though-he had completely torn his common digital extensor tendon (the one main tendon needed for movement of the limb) so had to repair that, then had torn right through both joint capsules, flushed very well with sterile saline and then closed the joint capsule and then closed the wounds...Also had a laceration on the chest that was easy to close...then I splinted the one leg with the torn tendon because he can't walk on it...going to be some long recovery for this guy....may not ever work again because may always be lame on that leg! Poor dog. What other cases have I seen? So many that I can't remember...saw a hit by car dog last night....no real external wounds...seems to be ok but monitored overnight anyway... Ok well I lost track of the time..I need to get ready to head back in for another day. God I am so tired. I just want a day off.

Hit-By-Car

I am the queen of trauma...if your dog/cat/whatever is hit by a car, send it my way...seems like that is all I have been seeing the past few days...and not just small accidents, huge trauma!! First HBC: 8 yo f/s Rottweiler - ran over by garbage truck, truck stopped on her back leg, then backed up real quick and degloved all the skin off the foot!!! Ouch!! Yeah!! She came in to me in shock of course...started her on fluids, administered pain meds and sedatives, ran some bloodwork, after stabilization took some rads of chest (to look for contusions-bruising in lungs), rads of left shoulder, rads of left leg...the story gets more complicated and sad for this dog - she has two different types of metastatic cancer - osteosarcoma (bone cancer in the left scapula) and mast cell tumor in the left hind limb (the one run over by the truck!!) Why does this confuse things? Because the wound on her back limb is so bad - down to the bone - tendons exposed - and ultimate treatment would be amputation...not an option in this girl because of the osteosarcoma in the front limb - she would not survive as a tripod - would probably end up with a pathologic fracture of that limb. Ok, more complications, dog is supposed to go through radiation therapy for the tumors at UW-Madison...not so much gonna happen now. Well, dad is a ER doc himself...has money...keeps saying no heroic measures for the dog...however thousands of dollars for an estimate and poor prognosis is ok!!! Moving on then...radiographs of chest show a possible nodule--even more negative strikes against this poor dog!! Luckily, amazingly - no fractures in any of the limbs, not even the one the truck was on. So, we get her stabilized and then bandage her limb, plan is to do dressings on the limb because I have to wait until all the tissue declares itself dead or alive before it can be fixed....this can be a long time...So, did honey bandages...actually placing honey on the wound (has antibacterial properties and also osmotic to help pull junk out of the wound)...Dog was doing well..sitting up, alert, actually walking on that limb (I also placed a hard splint outside the honey bandage just to give her more support in the limb)...dogs are amazing...you know that has to be painful...so she got an abdominal ultrasound yesterday because it was part of staging for the cancer---strike 3 -- masses in spleen...Dad visited, cried, going to euthanize today I think...amazing dog..made it through so much...so sad...I did one more bandage change last night and wound is actually granulating in very nicely...took some pics...scroll down after reading this blog to see the images...prepare yourselves!! so that was Lily dog...great sweet girl. My other HBC came in last night...8yo f/s Pug--laceration on top of head (down to skull...yes can see the bone...I mean the whole top of the head!!!..skin is pulled away!!), right eye was proptosed (popped out of the socket!!), dog can't use limbs, breathing horribly...so I go to talk to owner and find out.....she ran over the dogs head...oh my god...so I go through my schpeel...dog is very critical...head trauma..MRI/CT and wound surgery but not for couple days until stable...thousands of dollars..possibility of no dog after all this. Women has to run to bathroom....I do not know if she vomited or what,,,but then she came back and was able to place a small deposit for the first night,,,,but only for supportive care which means I didn't get any radiographs...Just lavaged wound on head and placed skin staples to hold it together so skull wasn't exposed, took minimal bloodwork, started pain medications and minimal fluids...monitored overnight...was doing ok but early in the morning began going into respiratory distresss.....last I heard the doc I rounded to was trying to get ahold of owners, they are a money case so I am afraid she may be euthanized....hey I tried...so her pics are below too. Ok, away from head trauma...you all saw the pics of the dog that ate the rocks..my first foreign body surgery...yay me..exciting even though I do not like surgery...dog did well and went home...phew, successful surgery!!! Last night was absolutely horribly busy...horrible...what did I see...a down dog with a disk lesion that transfered to another vet at 5:30am for back surgery to remove the disk; a couple vomiting dogs that just wanted outpatient treatment; saw a dog with a laceration on his metacarpal pad -- couldn't afford surgery so I cleaned and bandaged it and told him to see his vet for follow-up; some other lame dogs; euthanized a cat with feline aortic thromboembolism (heart disease and then throw clots to legs and basically poor prognosis). The other night, saw two Boston Terriers (Zoe and Milo) brother and sister who had eaten mom's ibuprofen supply!! This causes renal toxicity and GI ulceration in dogs...activated charcoal to vomit, IV fluid diuresis, pepcid, sucralfate (GI protectant)...continued to vomit through night...transferred to rDVM in am, hope they did ok,,,cute as heck...took pics of course...they are below on the blog also.... So now I finally have 3 days off...woke up early and got ready, met Talia and her boyfriend and then Andrea (a visiting vet from Italy) for lunch...that was fun..got some pics so see below as well. It has been storming like crazy here!!! Man oh man...lost power in the clinic one night a million times...not cool...That's about it...if I think of more interesting cases I saw the past four days I'll blog them later.

My First Surgery!!!

Finally got to do a surgery last night!!! Not until midnight when my shift was over--so I was there until 5am this morning...not fun...and the power went out in the clinic multiple times...luckily right AFTER I was out of surgery!! So, I am overly tired and have to head back in to work in about an hour. So my surgery...very cool...gastrotomy (cut into stomach to remove stuff)...dog at rocks!!! Yes, that's right, rocks, 10 big ones about half the size of my palm!!! Yes big rocks...stupid black lab!! Referring vet took radiographs and there they were, filling up the stomach..dog had been vomiting and owners had seen him playing with the rocks and figured he must have eaten them...well yes he did!! So, sent to us, I did bloodwork and guess what I found, do you remember from my last obstructive case?--Hyponatremic, hypochloremic, metabolic alkalosis...remember why?...because of pyloric (region of stomach that empties into duodenum/intestine) outflow obstruction...from the rocks of course. Went to surgery with the resident Dr. Torro - he is really cool, nice, an italian/puerto rican heritage so cool accent, not so bad on the eyes!!...it was fun, he is great and I am so lucky that he went in there with me instead of someone else (I think you all know who I am talking about, no names here!!). Yeah, so the bad part was that I had to do the surgery after my shift, was going to do it during, but working with the newest intern and I love her to death, she is so nice, but multi-tasking is not her strong trait and as you can well imagine does not work out that well in this job...so needless to say she saw about 2-3 cases the entire night and I saw everything else...does make me feel kinda good when my senior is asking my help though and saying I am sorry but can you please take one more case..because they know I can handle it....I don't know guys, am getting used to the job...although ya know I think that I still might want to do an internal med residency because I just don't really want to work these hours for the remainder of my life, I would like to have a normal life at some point...hang out with my husband!!! And although the surgery was cool...if I didn't have to do another surgery in my life I wouldn't be sad...I really do'nt think I like surgery all that much...it is cool to watch and hear about what they can do...other than that I am fine with it...with internal med I wouldn't have to do surgery...besides the meat and bones of the diseases are what is interesting to me. Other cases I saw last night were a dog with melena and very lethargic but pink mm (melena is black stool = digested blood = bleeding somewhere from upper GI), this was an old Rottie so my differentials are many but included tumor, ulcer, parasites, infection, coagulopathies (bleeding disorders)...owners have no money so gave SQ fluids and sent out door with sucralfate (GI protectant) and script for famotidine...treating for ulcers..told ot follow up at rDVM because dog is really sick, they won't I know this...what can I do. Saw my repeat offender blocked cat from the other night...this is his third night in a row back..Melvin is his name, yes he is a 'stupid yellow' who is still straining at home but everytime he comes in I am able to easily manually express his bladder and get a good normal stream...I think he is just having spasms in his urethra...so placed him back on Acepromazine (tranquilizer but helps with urethral spasms as well) and phenoxybenzamine (another urethral relaxant)...hopefully this works...the girl is my age and she laughs each time because it is always me who sees him and she teases now that Melvin just wants to come here to see me...she calls me his girlfriend...I think her husband is at the end of his rope with the cat, however luckliy she loves her yellow boy and is dedicated to his care...however if this keeps up the next step is to chop his penis (perineal urethrostomy...cut and reroute it to widen urethra so it doesn't block as easily). What else did I see? Another diarrhea cat...placed on fenbendazole (dewormer) and metronidazole (antibiotic) because she also had no money. Saw a dog with renal failure who is being treated by Dr. Kaae at the UW-Madison (one of the internal medicine residents) and her renal values are through the roof but refuses to hospitalize with us for fluids...wouldn't even allow an examination...just wanted bloodwork...talked to rDVM on phone and he tried to convince her to hospitalize and she just cried and he ended up saying she could bring the dog in to him tomorrow and they would place on fluids...faxed it al away and that's it...what else can I do..I find out later though that this lady was told not to return back to AEC..she is a little off her rocker I guess and causes troubles sometimes. I'm like oh great! I can't remember any more cases. My kitties were starving yesterday... I had no food for them and no time to go get then any before heading to work...yes, things were shredded when I came home!! Luckily I found one can of canned food last night for them and then got up early this am to run to store to buy them food. Only got 2 hours of sleep last night...really tired right now, two more days of shifts left then finally have some days off...may be able to get out of town even!! I am going to head out..we have journal club today and have 3 articles to read through that I read a while ago and want to peruse through quick so I re-fresh my mind on them. I am getting pics of my rock eating dogs so I will post those hopefully at another time. Adios.