Long Hours

Did I mention that Sunday's are horrible? I was the 8am to 8pm and I did not get out of there until 1am again. We were absolutely swamped all day!!! I admitted 4 again!! 2 goofs who ate chocolate and had tachycardia and vomiting and diarrhea. Chocolate as we all know has methylxanthines -which cause cardiac and neurological stimulation - leads to tachycardia, sometimes arrhythmias, GI signs, tremors, muscle twitches, seizures. So I had the dogs on fluids and continuous ECG monitoring...they were doing fine. Then I admitted a renal failure cat..Maya...she has bilateral ureteral stones...but they are not fully blocking the ureters. She is maintained at home with sq fluids, benazepril for hypertension (renal disease causes high blood pressure), and low dose Clavamox to ward off infection as the stones can serve as a nidus for infection. She had been vomiting at home and owners thought she was constipated. I did not feel stool in her colon on my physical exam. I recommended blood work and offered a radiograph (mostly so that I could prove that her straining was not from constipation). Radiographs showed the ureteral stones and surprise...no stool in the colon. Blood work showed elevations (above her normally high values) in her kidney enzymes so I recommended hospitalization and a recheck ultrasound, thinking this is either an infection she has and will just need stronger antibiotics, or she now has a full obstruction from the stones and will need surgery to remove the kidney or stones. Ultrasound showed the stones and also showed some dilation in the L renal pelvis (this is the ureter with all the stones)...it may have always been like this, but this could also be a sign of obstruction and urine backing up into the kidney. I talked with owners and we are sending out a urine culture to check for infection. I said that she will either improve and it is just an infection or she will continue to worsen and then it is prob. an obstruction. Recommended a recheck ultrasound in 1 week to compare the dilation...unless she continues to worse and doesn't leave the hospital. Hopefully she does good...she is a horribly mean patient to work with (have to knock her out!!) but her owners lover her and come on....you know I want the renal failures to make it through!! Speaking of Renal Failure...god I hope I get into either Davis or MN where they are top of the top in renal research because in the past two days I have lost 4 patients to renal failure!!! 2 due to money...1 due to other complications...1 due to complete anuric renal failure (this means the kidneys completely shut down and were not making any urine at all!!) That was a sad case...dad tried to give her such a chance...her name was tabby cat....but in the end I dumped a total of 800L into her and she did not make one drop of urine...after many long conversations with dad and many tears...he finally agreed to let her go about the time she was starting to look like the state puff marshmallow man....very sad case...but unfortunately in that case there is nothing to do at all. I tried giving diuretics and she had absolutely no response!!! Necropsy showed polycystic kidney disease. Sad case! My other one was another cat who the owners couldn't afford to treat at all...they euthanized right after I diagnosed it off of blood work...his name was 'Bug'...he unfortunately didn't get a chance...not sure what he would have done...would have really liked to see!! The other one was a dog with what we thought was Leptospirosis (infection, causes renal/liver failure)...owners gave him a good chance but in the end treatment became too expensive after his renal enzymes had started to creep up again and he was not able to tolerate any fluids...he too looked like a marshmallow. The last one was another cat...only 7months old..ended up having lymphoma in the kidneys...yes, cancer at 7months....very sad!! Then last night I admitted another dog, 11months old, with renal failure. Came in with no blood pressure..had to bolus both crystalloid and colloids - then it was up to 65mmHg. Then bolused dextrose and he bounced right up!! but sadly his renal enzymes were up. Ultrasound didn't show much. Submitted Lepto titers on him too, I am concerned in him that it might be this. My other suspicion was ethylene glycol (antifreeze)...but owner swears there is no chance and would not allow me to do the testing. He was doing ok when I left...hopefully he makes it. Hopefully it is just a pyelonephritis (kidney infection). So, my big ole sheepdog Moose is still in the hospital. He is doing great and is basically here because his owners are in Mexico. He will hopefully go home when they come back and do great!!! I love him, he is the sweetest dog in the whole world!!!! And his bill...a mere $20,000 and counting!!! Yeah so he damn well better make it!!!! I think the whole hospital would cry if he didn't! He's like a celebrity at AEC now. Saw a couple other lamenesses, a cat with an abcess on his foot, euthanized 5 which was very sad. Did CPR on one but unfortunately he did not make it. One other one came in dead after a patellar luxation - yeah I know, I am not quite sure if the owner are telling me exactly everything that was going on as I find it hard to believe that popping your knee out can kill you but hey...what do I know...knees are not my thing...give me the internal organs please...I don't care if ya can't walk!!! Well, I am on call now and I think I am going to see if something is on tv..don't feel like studying tonight. I might meet Rachel - our ex-intern - for dinner. She is back and working at a small clinic in Brown Deer WI...she loves it and says it is way more relaxed than AEC...except that now she refers to us... I don't know how she can do that...that would bother me knowing I know how exactly to treat the case but don't have the possibility...frustrating!!! THAT is why I have opted to give up the next 3 years of my life as well!!