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...