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March 15 Cool = SadIf you have read this blog for a while, you know that our job is interesting for many reasons. One is that we have cool patients – let’s face it – I get to play with dogs and cats at work. But another reason is that we are all scientists, and the challenge of the medicine gets us going too. But a fact is that some our most interesting cases can also be some of our most challenging and also some of our saddest cases. It’s an odd feeling to feel exhilarated by making a diagnosis of something uncommon, when the outcome is not good. A case I had this weekend is an example of just that. A five year old Lab came in collapsed. He was fine with the owners left early that morning, and he had been outside in a fenced yard during the day. When they came home, they found him unable to stand, and this normally happy guy could only give a weak wag of his tail. They lifted the big boy into the car and brought him in. When he got to us, he was laying on his side, unable to get up. His limbs were cold, he was in shock. He was very painful when I felt his belly. Even though he was so tense, I thought I could feel a large mass in his abdomen. “Uh oh,” I thought. This didn’t look good. Then I noticed a couple more things on my exam. His nipples were inordinately large for a male dog. And he only had one very small testicle in his scrotum. This means he was a cryptorchid, or that only one testicle had properly descended into his scrotum during his development. The other testicle was retained in the abdomen. So I started putting the pieces together:
This dog needed aggressive stabilization, a bunch of diagnostics, then surgery to explore his abdomen to see if my guess at his problem was correct. Unfortunately, his owner just could not afford any of this, and the prognosis was up in the air until we understood the tumor’s effect on the bone marrow (if removing the tumor did not reverse the effects of the estrogen on the blood counts, he would not survive). The owner decided not to let the boy suffer, and I euthanized him. It’s hard for me to euthanize any 5 year old dog, but not as hard as the decision that owner had to make that day. The owner did let me do an autopsy (in animals we call it a necropsy). The necropsy confirmed my suspicions – a torsed, cancerous testicle was the cause of the big Lab’s problems. This is a very uncommon problem, so for me it was very interesting – ‘a cool case’. Why do the cool cases have to be so sad? PS. This is why it’s important to have a cryptorchid dog neutered. Had this Lab been neutered (which would have involved opening his abdomen to get the retained testicle), this problem could have been prevented. It’s not a common problem, but it can be devastating when it happens. March 08 Why We Do What We DoWorking in a veterinary ER can be really draining. Death, grieving owners, and financial stresses all take their toll on our emotions. Burn out is common in any ER. Amongst the hectic parts of our job are sweet patients with an amazing will to live who remind us why we do what we do. It's these patients that make our job so extraordinary. Shane, a Miniature Schnauzer puppy, was one of these patients. Here is her story.
Shane, a 3 pound, 9 week old bundle of joy, originally presented to the clinic with vomiting and diarrhea. She had recently been purchased at a pet store. Her new family had barely gotten to know her yet, but it was clear that they loved her dearly. When a puppy comes in with symptoms such as Shane's, we always recommend beginning diagnostics with a Parvo test. Shane's test resulted in a strong positive. This adorable little fluffball had a long road ahead of her.
Parvoviral enteritis (Parvo for short) is a highly infectious disease of puppies that is typically fatal if not treated. The infected dog is suspectible to secondary bacterial infections and septicemia (bacterial invasion of the blood). Puppies with Parvo have severe abdominal pain, vomiting, and diarrhea (often bloody). Parvo is a serious condition which we prefer to treat aggressively. Unfortuantely, treating Parvo is NOT an inexpensive endeavor.
We began treatment by placing an IV catheter, starting fluid therapy, and giving her antibiotics and drugs to help with the nausea and pain. Bloodwork showed us that Shane needed a blood product called plasma. This is one of the more costly aspects of Parvo treatment, but it is also very effective. Shane rested well that night. She vomited a couple times, but did not have diarrhea. In the morning, she transferred to her regular veterinarian for continued care.
36 hours later, Shane was transferred back to our clinic because she was not doing well. She needed more plasma. Shane's family brought her to us in a box, wrapped in a blanket. When I went to the exam room to retrieve her, I pulled back the blanket and thought, "Oh no, she's in bad shape." I really didn't expect her to survive long. Neither did Dr. Susan. Shane's poor little belly was extrememly painful and she groaned with nearly every breath. Her heart rate was high, her gums were pale, and she appeared to be in shock. She was in critical condition. With consent from the owners to continue her care, we worked to stabilize her and make her more comfotable. My heart broke for this tiny fighter of a puppy.
Because Parvo is so infectious, the patient must reside in isolation. Those caring for the patient must wear protective gear to prevent carrying the virus to other areas of the hospital. One technician works with the patient per shift in order to keep others "clean". Anyone who has been in contact with the Parvo puppy does not touch other puppies or unvaccinated dogs during that shift. I was the Parvo tech on this particular night. I spent a lot of time with Shane and grew quite attached. Her condition improved slightly that night, but she was still very criticial. When my shift ended, I told Shane to keep fighting, but I also did not expect to see her the next day. I'm happy to say she proved me wrong.
The next night I was surprised and thrilled to see Shane. She was still criticial and had many lines running into her, as she was receiving multiple fluids, plasma, and a continuous infusion of pain medication. I lived in Parvo Land (as we affectionately call isolation) again that night. I spent hours cleaning up diarrhea, vomit, and urine. I attempted to keep Shane as clean as possible, but this can be a fruitless effort when dealing with Parvo. I monitored her fluids and gave her the drugs she needed. Her vital signs (temperature, pulse, respiratory rate, overall condition) were closely monitored. Eventually her bum became sore from the thermometer and the diarrhea. I took it as a positive sign when she started to squeal and squirm at temperature time. At least she had the strength to do that. After this night with Shane, I had a couple nights off. Again, I felt very unsure if I would see her again. Again, she surprised me.
When I returned after my time off, Shane had improved greatly. She was eating! And keeping it down! Hooray! I was so thrilled to hear this news, and I was even more thrilled to see it with my own eyes as she happily chowed down! That night I only cleaned up urine. She did not vomit, and she did not have diarrhea. Though she was not 100% better, she was acting more like a puppy. She loved to climb on top of a blanket we had given her to cuddle. She would climb it like a mountain, curl up in the middle, and take a nap. It was adorable, and it was wonderful she had the strength to do it.
The next day, Shane went home. I was thrilled to enter the exam room this time to smiles, rather than tears. I talked to Shane's family about the at-home care they would need to provide. They listened intently; it was obvious they wanted the absolute best for their sweet Shane. Then came the golden moment, reuniting Shane with her family. Because the family had had this pup for such a short time before she became ill, I was unsure if Shane would know them. Again, Shane surprised me. She wriggled and danced in their arms. The family was bathed in grateful kisses from their loving puppy. Everyone was overjoyed. It was a moment I will carry with me for a long time. March 01 Codi the Dog VS. Corn DogDakota (Codi for short), an eight and a half year old Terrier / Doberman mix, presented to the clinic Tuesday night because she had ingested a corn dog stick. I (Renae) was spending much of my time working with a Parvo puppy that night, but, fortunately, I was able to witness most of the happenings of this case. This was a cool one that Dr. Susan and all the techs were talking about for the rest of the night.
Codi's family was eating corn dogs that night, and, apparently, Codi was patiently awaiting her share of the yummy meal. Codi must have felt it was her lucky day when the family's son dropped his corn dog on the floor. No one saw her eat the dropped goodie, but all they could find left on the floor was a small piece of the stick. Lucky for Codi, her family knew the corn dog stick could be quite dangerous if it obstructed her GI tract or if it perforated her stomach or intestines. Codi's family quickly brought her to Dr. Susan.
Dr. Susan evaluated Codi. Her exam was within normal limits. She appeared to be a healthy, vibrant dog. The technicians took an x-ray of her abdomen. As we suspected would be the case, the stick was not visible on x-ray. We were able to see that there was food in the stomach, and, at this point, her GI tract looked normal. Dr. Susan presented the options to her family. They were as follows:
The owners elected to induce vomiting. We fed Codi a can of dog food that was well smashed and crumbled. The extra food in her stomach would help cushion the stick and decrease the chances of it perforating the esophagus. Then we walked her around and around the treatment room to help mix it all up in her stomach. Codi then received an injection in her vein of a drug called Apomorphine. This is for the induction of vomiting. Within minutes she was drooling and giving us that sad look that says, "Oh my, what have you done to me?!" Shortly there after, an eruption of cheers was heard throughout the hospital as the treasure was hurled onto the floor.... the corn dog stick, complete with the WHOLE corndog (see the picture below)! (Okay, we are medical people who are fascinated by gross things, but, surely, anyone would think this was very cool... Right?!) We promptly scooped up the corn dog and ran it out to Codi's family to show them the exciting results. They were equally happy. Pictures of Codi's forbidden snack were then taken by Dr. Susan and by Codi's family with their camera phone. Never has there been so much celebration over a soggy corn dog. In the end, Codi and her family went home happy and relieved. The decision to induce vomiting was the correct one. Dr. Susan and her team have a great case story to share. Codi's family was able to quickly solve their dilemma, and they have a unique addition to their collection of camera phone photos. And Codi the Dog triumped over Corn Dog. Note from Susan: Do NOT try making your dog vomit something like this at home. There are serious risks if the stick embeds in or punctures the esophagus. Codi's family and I had a long converation about risk/benefit. It all worked out for the best in this case, but every case must be individually evaluated by your veterinarian. February 28 Beethoven[This is Susan here - I think Renae will be posting another case later today or tomorrow.] One night a few weeks ago, it was cold here. Really cold. There was a lot of snow as well. A big St. Bernard named Beethoven came in to our ER that night. Normally an outdoor dog, he had a thick, heavy coat. But it was too cold even for him that night, and his owners had brought him indoors earlier that evening. That’s when they noticed something was not right with him. He seemed agitated, and he resented his owner handling him – he even went so far as to try to bite her. This was unusual for him, as his owners described as normally a happy, friendly dog. They also noticed he seemed to have some intermittent limping, especially in his hind legs, and at times yelped as if he might be in pain. At one point he seemed disoriented and started falling into a wall. He was trembling at times too. So they brought him in to see us. On first look, Beethoven did not look that sick. He did seem a bit agitated, but sometimes it’s hard for us to tell because we don’t know an animal’s normal demeanor. Being a big boy (who outweighed most of us), he was a bit hard to handle, as he resented our manipulation of him as well. On exam, nothing really stuck out to me. His temperature was a little high, but not too bad. He was panting a lot, but dogs that don’t want to be here in our ER do that a lot. He didn’t seem to have any obvious lameness, but occasionally lifted his legs, and at one point almost seemed slightly lame on front leg. I couldn’t get him to act painful when I manipulated his joints, but he was agitated enough that it was hard to tell. Beethoven had what I jokingly refer to as a ‘nebulopathy’. Some condition that was nebulous – hard to pin down. And I hate nebulopathies. They are usually a real pain to sort out. And a nebulopathy at midnight on a busy night is always a challenge. So I talked to his mom. I didn’t have much to go on, but something was not right with him. So I suggested getting some bloodwork on him, which is usually the place we start our search for the cause of a nebulopathy. We drew the blood (a chore in itself, because he was hard to hold – he just didn’t want us handling him). I waited impatiently for the results. And there it was: the level of calcium in his blood was dangerously low (hypocalcemia). The symptoms of hypocalcemia are agitation, rapid panting, sometimes itching of the face, trouble walking and a stiff gait, tremors leading to seizures, high body temperature and death if untreated. The most common cause of hypocalcemia is eclampsia. This is a disease where a nursing mother dog loses too much calcium in her milk, and her blood calcium drops low. We see this with some frequency in the ER. But Beethoven is a 9 year old castrated male dog, so eclampsia couldn’t be his problem. There had to be another reason. Some more diagnostic tests in the next few days showed that Beethoven had an uncommon disease called primary hypoparathyroidism. This condition is caused by a malfunction of two glands in the neck called the parathyroid glands. These two glands function to keep the calium level in the blood normal. When the glands don’t do their job correctly, the blood calcium drops too low. We threw a catheter in Beethoven and gave him some intravenous calcium (this has to be done slowly and carefully, as giving it too fast can actually stop the heart). He responded nicely, and within an hour, he turned from an agitated, grumpy dog into a funny, sweet big boy. Now he is on medication to keep his calcium normal. And here’s my theory on Beethoven. The cold weather saved his life. Had he been out in his doghouse as normal, the owners wouldn’t have seen his odd behavior. If they hadn’t seen it, his calcium level could have dropped low enough to kill him that night. The signs were somewhat subtle and non-specific, and probably would not have been noticed if he was not inside with his people. (They have decided to move him inside now, even though he prefers to be outside with his dog brother.) February 15 A Technician's PerspectiveI will start by introducing myself. I am Renae, one of Dr. Susan's technicians. I've been working with her for nearly four years. My first experiences working in veterinary medicine began with Dr. Susan when I was an intern. She has taught me A LOT along the way! She's a smart cookie, and she loves to teach, so I know I will continue to learn from her. Dr. Susan and I have been through many ups and downs together during our ER adventures. We have shared many laughs over the antics of our patients and over the goofy ways we entertain ourselves on the slow nights (from Dr. Susan's previous posts: fruit wars, dressing up clinic cats, making smiley faces on other technician's rear ends when there isn't a thing that tech can do about it - that was my rear end by the way, etc.). We have shared countless tears over ill and dying pets, often crying with the owners as they say good-bye to their beloved furry friends. We have also shared in the glory of many successes with our patients. There is no greater feeling than seeing a previously seriously ill pet wag his tail as he trots out of the hospital with his family. In the animal ER, Dr. Susan and the staff experience a roller coaster of emotions. It is a tough job, one that can truly take its toll on our lives. Along with the mental stresses, the hours are far from ideal; we work nights, weekends, and holidays. We often work very long shifts, sometimes with little to no break. Ask any one of us in that ER, we wouldn't trade it. Many of us, myself included, have tried working general practice at one time or another, and we've come running back to emergency medicine. ER is in our blood. We crave it. We love it. We thrive on it.
As an ER technician, it is my job to assist the veterinarians in the patient's care. I triage incoming patients (assess the pet's medical stability and determine the urgency of the situation), monitor and treat hospitalized patients, assist with surgeries and anesthesia, perform diagnostics (such as take x-rays, pull blood, run labwork, etc.), place catheters, prepare deceased pets for viewing or cremation, handle client communications, etc. A veterinary technician's job is quite diverse and never boring. In the ER, cases are often critical, and time is of the essence. Emotions are high for the staff and the patient's owners. It is not uncommon for the doctor to shout orders at the technicians. The pet's life is in the doctor's hands, and we, the technicians, are there to help carry out the life-saving actions in a timely manner. We may hear harsh words from the pet's owners as they are extremely stressed by the condition of their pet. Of course, we also sort through client's tears and their feelings of utter shock. It is the technician's job to help the veterinarian get necessary information from the clients during this difficult time, explain the situation to the clients, and help them understand and cope.
By far, the best part of my job is spending time with the patients. We like to joke about veterinary medicine being so great because you can't get kisses and snuggles from your patients in human medicine. You also don't enter an exam room and exclaim in a silly, high-pitched voice that the patient is adorable. The satisfaction of a tail wag and a slobbery kiss from a canine patient or a head-butt and a purr from a feline patient makes veterinary medicine number one! Other advantages of working in an animal ER include the excitement and adrenaline rushes, the unusual cases, the fact that we never know what our day will hold (surprises are fun!), and the bonds we have with our co-workers.
I look forward to sharing my adventures with you from a technician's perspective. My posts will be a little different from Dr. Susan's in that there probably won't be as much medical information. Instead I will try to give you a "behind the scenes" look into the ER ... the relationships we form with our patients and clients, our daily activities, and the roles of the techicians in treating patients. Dr. Susan and all the veterinarians at our facility are incredible doctors; I feel privledged to work with them, and I feel very comfortable knowing they are there for my pets if I need them. Dr. Susan has done a great job of sharing our ups and downs with you in this blog. Personally, I find her posts quite entertaining, and I live this stuff everyday! I must admit, it was very cool for me to come home from work, read about my night on MSN, and be able to share it with my friends.... "Check out MSN, and see what I did at work last night!" I hope you find my posts as enjoyable. I have big shoes to fill! I promise, I'll keep bugging Dr. Susan to add a post here and there. She's an awfully busy lady.... February 07 Hello!!Well. as those of you who still visit, I'm sorry I haven't written in so long. So, to help remedy my lack of writing and writer's block, my tech Renae (you may remember her as 'Mighty Renae' from this post) has volunteered to blog on our ER from her point of view.
Renae has been working for us for close to 4 years, all on ER. She has seen it all here. I hope you find her posts enjoyable. I'll be getting back to posting as well.
Thanks to anyone who comes back to visit!
November 04 Ups and downsLast night was a typical night in the ER ….
I had a patient that was not doing well – he was having some severe post-operative complications. From the minute I came to work, Barb and I were working on him, trying to figure out why he was crashing on us, and trying to figure out how to reverse what was happening. We fought for more than 6 hours, but were not successful – his decline continued. His mom and dad came to visit, and made the difficult decision not to go on with treatment, as his condition was rapidly deteriorating. It was hard to lose this one, especially when this turn in his condition was not expected. And he was a really cool dog.
While this scenario was happening, another previous patient came to visit. His name is Brutus.
Brutus came in several months ago with GDV (here is a link to another post on GDV). Brutus’ surgery was relatively uneventful for a GDV, but he also developed significant post-operative complications. He developed a bad cardiac arrhythmia. Now this is pretty common for a post-op GDV, but Brutus’s arrhythmia proved much more difficult than normal to control, despite several medications. He went into heart failure from this. Over the week, his condition went up and down, and one night I was nearly sure he was not going to live through the night. But his dad, and his dad’s mom (Brutus’ ‘Grandma’) wanted to keep trying, and we did. Finally, he started doing some better after that tense night.
He would not eat for us, so we sent one of our techs to the store for ‘magic food’ – Giant Eagle deli roast beef. Arby’s roast beef will do in a pinch as well. Brutus finally started nibbling at this for us.
However, just as we thought he was out of the woods, his abdominal incision broke down and needed to be repaired (this can happen in animals with critical illness, as they don’t heal as well as normal). At this point, his heart failure was under control, but he needed to go back to surgery, and anesthesia has a tendency to make the heart arrthymias flare up. We were very worried about his ability to survive if this happened. His dad and grandma thought long and hard, and decided they could not give up. He made it through the needed repair (his arrhythmias did flare up but were more easily controlled this time), and was able to go home a couple days later. Getting him back to feeling good was a longer process.
Last night his dad brought him to see us. This is real treat for us – we rarely get to see our patients feeling better (they usually go back to their regular veterinarians, or come in during the day when we are not there). Brutus looked so good! He was bouncing around and happy and giving us kisses. We had never seen him like that. His dad was beaming – he never gave up on him.
But here we were with Brutus in the lobby and his beaming dad, laughing and admiring the handsome boy. And in the treatment room, it was an entirely different picture as we were at the same time euthanizing our patient who was not making it through his post-op complications. It was striking dichotomy of feelings.
And that is a rather typical night in the ER. Off topicSome thanks are in order: Thanks to MSN for featuring this blog (and putting a pointer to me on their front page). I never thought anything to do with me would show up on MSN's front page!
Secondly, thanks to all for your comments. I'll try to answer what I can when I get a chance.
Third, and this is completely off topic - I'll vote for anyone who outlaws those dang political phone calls! Do they not realize some people sleep during the day? Do they not realize how much the public hates these daily, sometimes hourly intrusions in our lives? Are the horrible hate ads on TV not enough? Does anyone actually get their vote positively influenced by these calls?? Seriously, I am less likely to vote for someone who wakes me up every day (or more than once a day).
Political people - STOP CALLING! November 02 95 feetI was working on some paperwork in my office one night last week when the techs called out to me: “Hit by car is here!” This is a common call in any ER, and puts into motion a series of steps that occur automatically in any hospital.
The first step for any emergency is ‘triage.’ Triage is the process of initial evaluation when any animal walks (or is carried) through the door. The techs (or sometimes the doctor) will immediately do a basic initial assessment as to whether or not the animal is stable – this usually happens in the lobby, but may happen in the car, in the exam room, or in the treatment room. Any animal whose stability is in any question is brought, or ‘triaged,’ directly to the treatment room.
In this case, my techs triaged a big St. Bernard named Copper right in the car, hoisted him onto a gurney and wheeled him directly back to the treatment room. One of my techs, Renae, had been the one to lift this big boy out of the car almost by herself. Here is Copper, and mighty Renae.
  He probably comes close to outweighing her!
This handsome boy was in rough shape. He was breathing hard. His gums were pale, his extremities cold. His heart was beating very fast and I could not feel pulses in his legs. Copper was in shock. He did not respond to me, making me concerned for head trauma. At this point, I was not worried about broken legs, etc. In the great majority of cases, a broken leg is not going to kill my patient. Chest, head and abdominal injuries will. So that’s what I concentrated on.
Even as I was doing this initial assessment, the techs were giving him oxygen and putting an IV catheter into a vein in his front leg so we could give him fluids, and trying to measure his blood pressure. We started several different types of intravenous fluids at fast rates. This is to try to bring his blood pressure up to acceptable levels (we had a lot of trouble getting Copper’s BP to stay at acceptable levels, the reasons for which became clear later). When we did get his pressure up some, he did start responding appropriately to me calling his name, meaning that hopefully his head trauma was not too bad. We also started pain medications.
To help me figure out why he was breathing so hard, I put a large bore needle directly through his chest wall between 2 ribs and into his chest cavity. This is something called thoracocentesis, aka a chest tap. This was to see if Copper had a ‘collapsed lung’ either from air or blood buildup around his lungs. Sometimes we diagnose this with x-rays, but Copper was not stable enough to take to radiology. So we just tapped. Copper did indeed have a buildup of air. This is from his lungs being damaged when he was hit, causing them to leak air. We tapped more than a liter of air off each side of his chest.
At about this time, we noticed Copper’s abdomen looking more distended. A quick tap of his abdomen (this time by putting a needle into his abdominal cavity) revealed he was bleeding into his abdomen, most likely from his liver or spleen or both. Now, this is actually quite common for animals that have been popped by a car, and I was not surprised. But I was concerned – it is not common for the abdomen to visibly distend from the bleeding in just minutes. ‘Yikes’ is what I was thinking. We wrapped a pressure bandage around his abdomen.
I then tapped more air off his chest – this bought me some time to get set up to put a chest tube in. The chest tube was needed because Copper was building air up too fast for me to keep repeatedly drawing it off with a needle between his ribs. The larger tube allowed me to draw air or fluid from around his lungs and keep them expanded, and even allowed me to hook him up to a pump apparatus so his lungs would stay expanded without intervention from me.
You have seen a chest tube placement in people if you ever watch ‘Trauma, Life in the ER’ – the people always howl when they are getting these in – it looks really painful. Therefore, this is a procedure we like to anesthetize our patients for if possible, but Copper was not stable enough for even this short anesthetic procedure. I gave Copper some more pain medication and a sedative, put a local anesthetic in his chest wall, and placed the chest tube (this did not seem to bother him like the people on TV), then hooked him up to the suction apparatus. His breathing significantly improved.
With the chest tube in place, I could now concentrate on the rest of him.
Copper was very badly injured. I was not making much ground on his blood pressure despite giving large amounts of fluids. He had bad lung trauma and he was bleeding a lot in his belly. More than any trauma patient I’ve had in a while. Oh, and by the way, he developed a significant cardiac arrhythmia (abnormal heartbeat) from the trauma to his chest.
The bleeding in his belly was very concerning. Most of the time abdominal bleeds in HBC dogs will stop on their own. Copper’s appeared to be stopping more slowly than I was comfortable with. And this is when we have decisions to make in the ER. And it doesn’t seem to matter how many times I run up against this situation – each and every time I agonize over these decisions.
Take him to surgery to stop the abdominal bleeding? There are proponents of this course in a patient like this, and this is a common course in human trauma medicine – stop the bleeding, and breathe for his bad lungs during surgery, and hope he makes it through surgery. And hopefully his abnormal heart beats are not made worse by the anesthesia. A dicey proposition at best. The other thing to do is keep supplying him with enough fluids to keep his pressure up, meds to keep his heart arrhythmia calmed down, and we were already doing the best we could for his lungs with oxygen, the chest tube and continuous suction. (The next step for his lungs would have been to put him on the ventilator, but he did not progress to needing that.)
So I elected the second option – keep him stable without surgery. I felt it gave him the best chance. I was very worried that with his bad lungs, he would not make it through surgery. If I was wrong, he would die.
The rest of that night was a rollercoaster of high heart rates, varying IV fluid rates, dropping red blood cell count (he got a blood transfusion for this) and cardiac arrhythmias. And the constant drone of the little person in my mind: “Am I doing the right thing??”
By morning, Copper was still critical but a bit more stable – lower heart rate and acceptable BP. I transferred him to our surgeon, Barb, for continued care. He had some significant complications over the next 4 days that required multiple blood and plasma transfusions, at significant expense to his family. But he was well enough to go home on the 5th day. And the whole time, he was a great patient – he was wagging his tail when he could barely lift his head.
When Copper was well into his recovery, his mom told me he had actually been thrown 95 feet (!) by the car that hit him (and he weighs 110 lbs!). It’s amazing he even survived to get to the hospital. His family did a great job getting him to us.
It’s good to get him home. But I still wonder if I did the right thing that first night. Would his recovery course been as complicated if we had made the choice for surgery? I actually think it would have been more complicated with surgery, but I’ll never know. These decisions and cases are what keep emergency medicine so challenging for me. It just doesn’t get old.
 October 31 The Bimini BulletTo those of you who may be a little squeamish, this post contains some graphic pictures. Saturday night as we were getting ready to find some dinner and a cold beer, one of the islanders brought a young dog to us. She was emaciated, pale and weak. He didn’t know who owned her (although we did get some conflicting reports on that). Dr. Grant examined her. She was a pit bull mix. There are now more pit bulls than there used to be on Bimini, and the pups born to potcake/pit bull matings are called ‘pitcakes’. This little girl was either a pit bull or a pitcake. As perhaps you may be aware, pit bulls are sometimes used in dog fighting. This is a horrible and cruel ‘sport’, illegal in most places. Some of the people who fight these dogs have their ears cropped short so the ears cannot be bitten during a fight. Even if they don’t plan to fight the dog, some people have the ears cropped to make the dog ‘look tough’. Most veterinarians won’t do this procedure on pit bulls. However, sometimes people will attempt to crop the ears themselves. This is just what happened to this little girl – someone wrapped fishing line around the base of her ears so tightly they rotted and fell off. The left ear was gone, the right was hanging by dead tissue. Here are the pictures:  
We were horrified. The smell of the wounds was awful, and this poor girl was so sick. Yet she was very gentle and quiet. She let Dr. Grant and Martha examine and clean her a little (we gave her some pain meds first). Then we attempted to get permission to either treat her or euthanize her. Initially the police thought they could locate the owner, but when they couldn’t, they basically turned her over to us and we went to work. We anesthetized her and Martha and Dr. Grant each went to work on an ear.  
It was painstaking work to debride all that dead tissue, but after 2 hours, this was the result: 
She recovered well, and we dewormed her and gave her antibiotics and medication for the diarrhea she had. We went and scrounged up some food for her and us (by then all the restaurants were closed) and got some sleep. The next morning, she seemed a little more alert and comfortable. The question now was not whether she would survive – we felt she would. But what were we going to do with her? Taking her home with us was not a good option – as you may know, homeowner’s insurance is very difficult to get now if you have a pit bull, and although we all loved her, getting her a place to stay on such short notice seemed a tall order. Nowdla came to the rescue – she called the staff at the Sharklab. They came to visit this little girl Sunday night, and agreed to take her in. They seemed charmed by her quiet, gentle nature despite her horrific wounds. The Sharklab staff helped get us and all our equipment to the airport on South Bimini Monday morning, and picked up the little dog at the same time. 
We said good-bye to her – it was hard to believe how attached we had gotten to her in such a short time. We said to one of the Sharklab staff members that at least if they could foster her, we could work on finding her a home in the States. He said to us, “you’re going to have a hard time getting her away from us.” We knew then that she was with people who already loved her. The next day, this post was on the Sharklab’s website: http://www6.miami.edu/sharklab/news.html. Notice the handpainted sign with her name. I think Bullet has found her forever home. What do you think? ps. Even if for some reason in the future the Sharklab cannot keep Bullet forever, we will make sure somehow that she has a loving home. October 30 BiminiWednesday, October 18th: I fly from Columbus to Orlando. Martha, Consie and I complete organizing and packing our equipment (Martha, Consie and Martha’s technician Jessica had done most of that previously).
Thursday October 19th, 6 am: Martha, Consie, Martha’s nephew Danny, Jessica and I pile into Consie’s truck for the drive to Ft. Lauderdale. We arrive in Ft. Lauderdale at about 10am, scrounge up some breakfast, and check in for our flight to Bimini. We greet our plane and pilot: 
(yikes! That’s a little plane!)
The pilot loads all our stuff into the plane, and off we go. This is the south Florida coastline: 
We fly over Bimini. Bimini is actually 2 islands – most of the population lives on North Bimini, an island that is about 7 miles long and less than 700 feet wide at its widest point. South Bimini is home to the Bimini Biological Field Station, aka the Sharklab, a research station for sharks, particularly lemon sharks. The airport is also on South Bimini.
We clear immigration and customs. The immigration officer looks at our papers and asks us why we are visiting Bimini. When he finds out we are ‘the vets’, he smiles and tells us we will be seeing his Chinese “pub”. And here is his little Pug with his mom (also an immigrations officer), and Dr. Grant, the Bahamian veterinarian on our team. 
Nowdla and her daughters Shannon and Kaila pick us up in their boat for the short trip to North Bimini. Nowdla and her husband own and operate Bimini Undersea. They also love the potcakes, and have helped coordinate our trip (and the team’s previous trips) to the island. Nowdla has posted these signs around the island: 
We unload our equipment and pack it on a golf cart to take it to our makeshift clinic (most people get around in golf carts on this tiny island). There are two roads, ‘the high road’ and ‘the low road’. One person drives the cart to the clinic, the rest of us walk the short distance.
The clinic is a building that unused and locked. There is no water and electricity, but Nowdla is working on that. We arrive at the clinic to find this: 
Some poor homeless man has set up camp on the porch. And unfortunately, he has used the porch and steps for his bathroom as well. He is nowhere to be seen, but we will have to deal with this before we can get to work.
However, we get to play a little first. Bill and Nowdla have offered to take us out to swim with the wild dolphins! We eagerly take them up on this offer, and spend a beautiful and relaxing 4-5 hours in the warm sun, looking for dolphins. Unfortunately, the dolphins did not want to come out to play with us that day (we did see a few on our way back in), but I hope to see them on a future trip. Here is sunset from the boat: 
7am Friday: We head to the clinic to get set up. We ask our homeless guy to move across the way to another spot. We feel bad for him. This is when I wonder if helping the animals is how I should ‘give back’. Maybe we should be helping him instead of the potcakes. Jessica brings up a good point: Do what you know how to do best. She is right, and we proceed to clean the porch and the rest of the clinic.
Friday we have no running water, and we do not have electricity until the afternoon. We make do with getting buckets of water out of a well for cleaning, and with bottles of water for washing/prepping for surgery. We spend all Friday morning cleaning and setting up. Here is our surgery room ready to go: 
Notice the phone books used to get the table to the proper height. Nothing fancy here!
Then our first patient shows up: Pooh. 
Pooh is very sick – not the way we expect to start our spay/neuter clinic. He is very cold and very pale – he needs a blood transfusion. So Nowdla rounds up a friend’s dog, Duke, and we draw blood from Duke and transfuse it into Pooh. Pooh perks up over the afternoon, even starts wagging his tail and eating for us. (Unfortuntely, Pooh passed away a few days later.)
Martha’s first surgery patient is Midnight. Midnight is a 10 year old dog who had been making babies all over the island for a long time – Martha knows him from her previous trips here. His owners consented to finally have him neutered. Here is Martha and Midnight after the ‘deed’ was done: 
The rest of Friday and Saturday are spent getting dogs (and a few cats) in the door, setting up our makeshift recovery room, and spaying and neutering (Martha did all the surgery, I did anesthesia and other tech work, Jess and Danny took care of intake and recovery, and Consie organized everything else). Dr. Grant and his volunteer assistant, Arietta, see many patients for vaccines, heartworm preventative, etc. Here is our recovery room: 
Late Friday, Dr. Grant and Arietta are called out to check on an injured stray dog. She had been shot 6 months previously and paralyzed in her hindquarters. It was sad and disturbing for the islanders, but they have no veterinarian on the island (Dr. Grant can only visit every few months). She has been dragging herself around, is very thin and has wounds on her back legs. They trap her, and with all of us gathered around speaking quietly to this brave girl, Dr. Grant euthanizes her. We then take her to a beautiful site on the island, and bury her. Nowdla’s daughter, Kaila, asks that we put these flowers on her grave, and we do. It is a somber moment that brings tears to my eyes. 
At 7am Saturday morning, we start in again, and really get into a better groove and get a bunch of spays and neuters done. We still have no running water, but we do have electricity. We make do.
These surgeries are more challenging than your average spays and neuters in the US. Many of these dogs have heartworms, some have a tickborne disease called Ehrlichia, and many are pregnant or in-heat. All these things combine to make them bleed more than normal. Even their skin is tougher than the average US dog. They are hardy dogs! This picture is a dog under anesthesia - the little black spots are all the ticks crawling off her! 
Martha and Consie have set these clinics up to give these dogs the best care possible – they all get IV catheters and fluids, they all get intubated (a tube into their trachea to deliver oxygen and gas anesthesia and to protect their airway) and pain medications post-operatively. This is not the case for all of these types of low-cost clinics in other locales. We get donated what we can to help cover the costs.
Late Saturday evening, as we are ready to pack it in for the day (after 12 hours of surgery), we get another sick patient surprise. I’ll talk about that in my next entry. October 28 Just another spay in paradiseSeveral years ago, a woman named Judy Troiano was diving on the small island of Bimini (in the Bahamas) and saw that the island had a large stray dog population. Most of these dogs are Royal Bahamian Potcakes. Potcakes are basically mixed breed dogs, and the name potcake is derived from a popular Bahamian dish, beans and rice. The “cake” that stuck to the bottom of the pot was thrown in the yard for the dogs, hence the name potcake was born. It is an officially recognized breed in the Bahamas.
When Judy went to Bimini, there were many packs of dogs roaming the island. They were not spayed or neutered, and were multiplying. Many of the owned dogs on the island were also not spayed or neutered, and those litters were adding to the stray dog population. To combat the problem, the dogs were being hunted and shot, or occasionally poisoned. Sometimes an owned dog would be mistaken for one of the strays and killed. The stray dogs were often fed by the islanders, making them easy prey for hunters.
Judy was determined to help these dogs. She formed a program called the “Bimini Love Program”, through All-Paws Rescue, a rescue organization she founded in her home state of Massachusetts. She coordinated volunteer veterinarians and staff on the island to hold a spay/neuter clinic on the island in June of 2000. This was a significant logistical feat, as the island had no veterinary clinic or equipment (a visiting veterinarian from Grand Bahama visits every few months to care for owned pets). That clinic was the first, and my friend and colleague, Dr. Martha Kehoe, was one of the veterinarians on that trip. She and the other volunteers spent long hours in the heat trapping, examining, treating, and spaying and neutering dogs. She was also captivated by the hardy potcakes, and became devoted to helping them.
During that trip, Consie von Gontard was on a diving trip to Bimini. Another animal lover, Consie was also concerned about the plight of the strays. She heard that “the vets” were on the island, and she went straight to the makeshift clinic they set up, asking “How can I help?” Consie spent the rest of her vacation trapping dogs, running errands, coordinating, and doing anything she could to help the vets help the potcakes. A short time after this first clinic, Judy passed away. Consie then volunteered to take the program on, and became a tireless supporter of animals in need. Since then, Consie has spent innumerable hours helping the animal victims of Katrina, the Tsunami of December 2004, and many others. She and Martha and many other volunteers have made multiple trips to Bimini to help the potcakes.
I became lucky enough to help the potcakes when Martha and Consie asked me to join them on the latest spay/neuter trip to Bimini last week.
Next entry – our trip to Bimini.
ps. If you want to help the potcakes, you can send a donation to:
All Paws Rescue
925 Bunker View Drive
Apollo Beach, FL 33572.
The check should read "All Paws Rescue-Bimini Program". The donation is tax-deductible.
October 15 Treating fleasI am going to interrupt the series on cat heart disease for a couple of posts - this one is not a happy one.
A little kitten came in the other night - the owner had accidentally put her dog's flea product on the kitten. The kitten was starting to have tremors.
This is something we see with some frequency. These are products bought over the counter, and they have an insecticide called permethrin in them. This is a product that is generally well-tolerated by dogs. However, cats are not small dogs, and cats do NOT tolerate this medication - they are much more sensitive to it. Some people accidentally put the dog tube on the cat, some people actually think well, just a little should be ok, and try it on the cat. I've even had people figure that since it was bought over the counter, it should be safe, and they've put the whole large dog tube on a cat. The more the cat gets, the bigger the problem. The ironic thing is, there are products available that are much safer and in my experience work a lot better. (Most of the cats that come in with this toxin still have fleas running around on them!).
Permethrin in cats causes potentially severe tremors and seizures. The worst of these last anywhere from 24-72 hours. We bathe the cats to get the product off, then treat them with a muscle relaxant called Robaxin first, then we move on to other drugs as needed (there is a limit on how much Robaxin we can use). Sometimes the tremors are quite challenging to get under control, and we really have to work at it with multiple drugs, lots of TLC and nursing care, etc. Once the tremors are controlled, the cats generally start eating, but may have residual twitching for a week or so.
Until today, I had not lost one of these that I tried to treat. But for some reason, this little kitten's tremors were very bad, required lots of medication. I don't know if he had a side effect from the medication, or if he had some other problem on top of the medication. But we lost him today, and it just tears me apart because this is so preventable.
So, DON'T put your dog's flea medication on your cat. (BTW, these medications are clearly labeled not for use on cats). Better yet, get Frontline or Advantage from your vet (I think you can get these online too). I am not one to push specific products here, but these two products are so much safer and so much more effective. A warning though - the dog product Advantix is NOT safe for cats (causes tremors as well). So don't confuse Advantage with Advantix. Better yet, always double check the label before applying the product.
Oh, and if you do use one the permethrin products on your dog (check the label), don't let your cat around your dog. The cat can rub on the dog and get sick just from that.
October 12 Mike's heartIn the last entry, I talked about Mike's diagnosis of HCM (hypertrophic cardiomyopathy).
What is this exactly?
'Cardio-' means heart, 'myo-' means muscle, and '-pathy' means disease or disorder. 'Hyper-' means increased and '-trophic' means growth. So basically, HCM is a disease of the heart muscle in which it grows too much. In other words the heart muscle becomes too thick. This is the most common type of heart disease in cats.
As you all may be aware, the mammalian heart has 4 chambers. Blood comes from the body into the right atrium, then to the right ventricle which pumps the blood into the lungs to pick up oxygen. The blood then flows into the left atrium and down into the left ventricle, which is the main pumping chamber - when this chamber contracts, it pumps blood into the aorta (the big main blood vessel leaving the heart) and out to the body.
Here is a link to a site with a picture and more detailed information on the normal heart: http://www.nhf.org.nz/index.asp?PageID=2145828141
HCM causes the heart muscle to thicken, specifically the left ventricle, which is already the thickest part. (See this picture to get an idea of the effects on the left ventricle.) When this chamber gets too thick, it can't relax enough to fill properly, the blood coming into the left ventricle from the lungs has a tendency to 'back up.' In response to this, the left atrium can enlarge. So sometimes you see a big heart or big left atrium on x-rays, but sometimes you don't. Echocardiogram (ultrasound of the heart) is the best way to see what is happening with the heart. This is the test that Mike and Mitch both had with the veterinary cardioligist.
In most cases, we don't know the exact cause of HCM, but there are a few underlying conditions that can cause similar changes in the cat's heart, such as high blood pressure, hyperthyroidism (hyperactive thyroid gland), and some congenital disorders of the heart.
Ok, so Mike's heart is a little thick already, and probably will get thicker, and his left atrium may enlarge. What does this mean?
Cats with this condition can do one of several things:
In the next posts, I'll go into more detail on the above conditions and how they present to us in the emergency hospital. (This post would get way too long if I tried to do them all at once.) October 09 The heart of the matterHey, after a 2 month break, it's about time I get back to writing, no??? (I really hope to do a better job of keeping up this time!)
I wrote a few months ago about the two new additions to my house, Mitch and Mike the kittens. The have grown like weeds, and continue their kitten antics (taking all the toilet paper off the roll is Mitch's particular favorite).
A couple of months ago I was getting ready to neuter them. I noticed one day that after racing through the house (as kittens will do), Mike was panting. He had been playing with Mitch, who was running just as hard, but Mitch was not panting. Hmmm, I thought. I tried to listen to his heart, but he was squirmed and purred and it was tough (I suppose you could also say I don't have that much control over my own animals...)
As you may know if you have cats, they are considered obligate nasal breathers. In other words, they don't normally pant like dogs. There are a few things that will make cats pant. The bad things that can cause panting are lung disease or injury, and heart disease. If they get too hot they will pant until they cool down. And I've seen a few other things (for example, a diabetic cat that gets too much insulin may pant). Some cats pant in the car on the way to the vet - this is from stress. Usually that type of panting settles quite quickly. And sometimes very, very sick cats may pant in the absence of obvious lung or heart disease - in my experience this is a bad sign.
And of course, a crazily playing kitten might pant briefly, and this is what I figured was up with Mike.
So I took both Mitch and Mike into the office one day, planning to take chest x-rays of Mike just to make sure everything was ok, and then neuter them both.
I got one of my techs to hold him, and listened to him with my stethoscope. And then I heard it - a definitely abnormal heartbeat. I ran an ECG (electrocardiogram) on him - he was having something call premature ventricular contractions (PVC's, sometimes called VPC's). This is NOT normal in a cat. So Mike and Mitch got appointments with the cardiologist for an echocardiogram (ultrasound of the heart).
It turns out that Mike has a type of heart disease called 'hypertrophic cardiomyopathy', or HCM for short. This is the most common type of heart disease in cats, although to have it diagnosed at such a young age is quite uncommon. HCM causes the heart muscle to become abnormally thick. Unfortunately there are no proven ways to slow the progression, so how long Mike can last with it depends on how fast his disease progresses. The fact that he has VPC's so young is concerning.
Mitch's screening was normal, and he will be rechecked in 6 months.
BUT, all is not bad - he does not know he's sick - he still runs around like crazy. My friend and colleague Barb neutered him and Mitch for me without any problems (anesthesia can be a little tricky in an animal with arrhythmias). He is now on medication to try to keep his heart rate controlled.
In the next post, I'll talk about potential problems in Mike's future. August 04 The great pretenderFancy is a very cute little Yorkie. She is about 8 years old and well-cared for (spayed, current on vaccines, etc.) She came in one Sunday a few weeks ago. Her owners reported she was feeling off since about Friday, and hadn’t eaten at all. Sunday morning, she started having little head bobbles and then would just collapse to the floor. She just seemed very weak. My techs brought Fancy to the treatment room immediately as she definitely was weak and dull. And sure enough, her head would wobble sort of like a bobble-head, and then she was just sink to the treatment table. We quickly ran some bloodwork on her. Her blood glucose was dangerously low – an unusual finding in an 8 year old dog. And given her state, her heart rate seemed too low. But as always in the ER, first things first – stabilization. I went to put an intravenous catheter into her front leg. This turned out to be a challenge – not only is Fancy a small dog with small veins, her veins were collapsed from low blood pressure. I had to resort to something called an IV cutdown. This is where I put some lidocaine in the skin (to numb it), and then I make a small incision in the skin over the vein with a scalpel blade. Then I take a small pair of hemostats (‘clamps’) and spread the tissue under the skin until I can actually see the vein. Then I can feed an IV catheter directly into the vein. We don’t normally have to resort to this – we often put IV catheters in puppies and kittens weighing less than 1 lb without cutting them down. But when a dog is not stable, we don’t have time to waste poking and prodding, and a cutdown is quick, easy, and most importantly, effective. The IV catheter was in. It’s always a relief to have that intravenous access in a critical animal. We started giving Fancy some fluids, and I drew some more blood for more specialized testing. Then we gave her some intravenous dextrose (sugar solution). We gave her some additional fluids to try to get her blood pressure up. But as always when we are stabilizing an animal, my mind is racing ahead and waiting for the rest of the diagnostics. What was wrong with Fancy? She had no history of trauma, and only vague signs of illness (lethargy, weakness and inappetance). The next bloodwork results gave me a big clue. Her serum potassium level was high, and her serum sodium level was low, along with her glucose and serum calcium. I began to strongly suspect she had something called Addison’s Disease (hypoadrenocorticism), and that she was having an ‘Addisonian crisis.’ (Diagnostic testing completed the next day confirmed this.) Addison’s disease is caused by inadequate production of vital hormones by the adrenal glands. These hormones allow the body to respond to normal stresses and regulate electrolyte concentrations in the blood. It can also cause the low blood glucose Fancy had, and a variety of other signs. These dogs may have have vomiting and diarrhea, heart arrhythmias caused by the electrolyte abnormalities in the blood, poor appetite, lethargy, weight loss, dehydration, kidney value elevations, or the vague ‘ADR’ (Ain’t Doing Right), . Because it can cause so many different symptoms, it is sometimes called ‘the great pretender.’ The breeds most commonly affected are Standard Poodles and West Highland White Terriers, but any breed can be affected. The typical age of diagnosis young adult to middle-age. It is rare in cats. People can get it too – President Kennedy suffered from Addison’s. The most common cause is destruction of part of the adrenal gland by the animal’s immune system. Other causes include abrupt withdrawal of steroid administration (this is why if your pet is treated with steroids for any reason, the dose must be tapered down). The classic presentation of Addison’s Disease is shock and collapse, and this is what Fancy had. This is actually not that common, but they really emphasize it in vet school, so it’s actually sort of fun to see the Addisonian crisis. The other reason it’s fun is because most of these dogs respond well to IV fluids and supportive care. And Fancy did just that – she was up and barking and eating by the next morning. And the last reason we like it is because although it cannot be cured, it can be treated with good success. These dogs need life-long medication (this can be expensive in large dogs). July 27 Sorry!!Sorry for not posting! It's been a bit crazy, and I just haven't had much time. I really appreciate you all asking about me.
Also, I kind of feel like I've run out of things to talk about. But I'll come up with something. In fact, I had a classic case of Addison's Disease not too long ago, so I'll describe that in my next post. It's a 'classic emergency'.
Thank you all for asking about me. We are all fine. Mitch and Mike (the new kittens) are getting big and are pretty crazy. And VERY cute.
My own dog Daisy had a bit of a health scare. She started getting some blood in her stool, but otherwise seemed to feel ok. So we checked some bloodwork on her - her liver values were elevated. We put her on some meds for that, and Hilary (our internal medicine specialist) did a colonoscopy (ouch!).
Her biopsies came back 'inflammatory bowel disease' - or chronic inflammation in her colon (we see this with some frequency in animals). So she went on some medications and a special diet. So far so good - nothing real bad, no cancer, etc.
Only about a week later, she started getting a small prolapse of tissue from her anus. (Ouch again!) Every time she had a bowel movement, the tissue came out. She also still had the persistent blood in her stool (just small amounts). It turns out this thing had developed into a polyp (that was not there when we scoped her). And the polyp kept poking out everytime she had a BM.
So we rechecked her liver values before we put her under anesthesia again to take the polyp out - they had gone up a lot despite the meds. And I started getting really worried, and we delayed taking the polyp out. So this time we got a biopsy of her liver. It didn't show anything significant - just some inflammation. More meds. For 4 weeks.
I found that I could just push the polyp back in when she pooped. Poor Daisy - she got to the point that when I said "Show me your butt" she just plopped on her side with a very resigned look in her eyes.
And a couple weeks ago her liver values were better, and we got the dang polyp out!
(But she'll still plop on her side every time I say 'show me your butt.')
And to add to the embarrassment for her, her rear end is shaved, so now I call her 'Baboon-Butt'.
Poor Daisy. May 26 Forrest's surgeryI think I've posted several times about Forrest, the little Pug. Forrest is the product of bother and sister parents (the parents and pups were rescued by Ohio Pug Rescue). Forrest was born with both back legs deformed. One leg responded well to physical therapy by his foster mom, Kim, but the other did not. It twisted around behind him, and decreased his mobility. Kim planned to have the deformed leg amputated as soon as he was over 5 lbs.
Here is Forrest at home - see how his left leg folds back abnormally (and yes, he is the one that chewed the chair leg up):
The week before Christmas, he began vomiting some. He seemed to feel ok, but wasn't responding well to symptomatic therapy. On Christmas eve, Forrest became depressed, stopped eating, and started struggling to breathe a little. Kim brought him into us on emergency. X-rays revealed the source of his problem - he had megaesophagus. He was born with an esophagus that does not contract and push food down into the stomach appropriately, and this causes him to regurgitate. Regurgitation is sort of like vomiting, but there is no abdominal press to it, and it is more of a surprise to the animal. This means the stuff comes up and out with no warning, and because it does surprise the pet more, they are more prone to sucking some of it down their trachea into their lungs. This is called aspiration pneumonia, and Forrest had a pretty good case of it. Luckily he responded well to treatment for the pneumonia.
Because of the megaesophagus, Forrest now had to be fed a gruel food in an upright position, and initially he needed to be fed every 4 hours. Kim gave him great care - let me tell you this was a tremendous amount of work! But he grew and did well, with no more bouts of pneumonia. The next step was to get his leg off so he could be more mobile.
Kim scheduled his surgery one day in April. She brought him in 36 hours before surgery so we could put him on fluids and fast him to try to make sure his esophagus was completely empty. There is always a slight risk of aspiration any time an animal is anesthetized, but Forrest was at more risk than a normal pet. Then we got ready for surgery, only just prior to the surgery, we noted his IV catheter (which had been in for 36 hours as this point) was blown. So we put another one in another leg. Or I should say we tried to put another one in. It turns out Forrest has very bad veins (I had actually noted that when we treated him for his pneumonia – it was a real challenge to get an IV catheter into that little pup). We tried, and couldn’t get a catheter in – at one point, one looked good, but it stung when we gave him his preanesthetic sedation – this is a sign that the catheter may not be good. Barb, our surgeon, decided to stop. Things weren’t going well, this really was an elective surgery, and there’s no reason to force things. When you start forcing things, bad things start happening. So we stopped, and sent Forrest home to give his veins a break. This was a tough decision for Barb, and it was really hard on Kim, who was very nervous about this surgery. But Barb figured better safe than sorry.
Finally a couple of weeks ago, Barb did his surgery. His catheter was still tough, but we got it in, and the surgery went off without a hitch. Barb neutered him at the same time.
Here are some pictures of the process.
Forrest prior to surgery:
Waiting for surgery:
Getting his IV catheter in (he looks worried, doesn't he?):
Intubation (putting a breathing tube in his trachea):
Hey!! Where's my leg?? (Kim took this one of him at home.)
Kim just sent me this link - a video of him motoring along post-amputation. He really moves (and Kim, let me warn you - he will get faster!
May 16 Mitch & MikeOk, this has nothing to do with work.
How cute are these two??
  Mike Mitch (with Mike climbing on his back) This is PJ, sitting on the end of the couch giving me a dirty look because of the two interlopers in my lap.
Yes, Mitch and Mike are two new additons to my house. They are stray kittens rescued along with their mom by our office manager, Heidi. I'm not exactly sure how I got talked into this. But dang, they are cute! I haven't had a kitten in years (all my other cats were adopted as adults or older kittens). However, the last adult cat I adopted drove PJ to live under the bed. So I thought maybe she'd take to little kittens a little better. Only time will tell....
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