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 ;)