Tuesday, November 13, 2007
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...
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The Story of the Five Balls
Imagine life is a game in which you are juggling five balls. The balls are called work, family, health, friends, and integrity. And you are keeping all of them in the air. But one day you finally come to understand that work is a rubber ball. If you drop it, it will bounce back. The other four balls - family, health, friends, integrity - are made of glass. If you drop one of these, it will be irrevocably scuffed, nicked, perhaps even shattered...either way, it will never be the same and may be lost forever. Be careful when life starts to get rough...juggle carefully. And, once you truly understand the lesson of the five balls...you will have the beginnings of balance in your life.
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