Monday, June 30, 2008

oh sweet verdant days of july

i "officially" start work tomorrow. translation: i have already worked 70+ hours unofficially. perhaps i should have waited for the orientation. it might have helped some in easing the transition into paperwork, speaking with referring veterinarians, protocols for certain emergencies - that sort of thing. but i don't regret starting early.

what am i looking forward to in july?

-working the 4th of july all day (NOT!!)
-the avett brothers concert july 12 in bristol
-new avett brothers EP: the gleam 2, july 22

sad, but that's about it. i have to work on the 4th, so no family time for me.

Tuesday, June 24, 2008

king kong on the stomach

after working 13 hours on sunday, i was ready to call it a night. but there were so many patients in the ER waiting room that i decided to take just one last case before calling it a night.

my patient was an 11 month old whippet, according to the card. in the flesh, he looked like a jack russell terrier mixed with something slightly larger but still very terrier-ish. his owner reported that she'd been out of town for 5 days at her father's funeral. she'd left the dog with her boyfriend. on the first day she was gone, the dog had eaten a tube of gorilla glue. FIVE DAYS previously. when the dog (heretofore max) began vomiting shortly thereafter - the boyfriend kicked max outside and left him there for five days. when the owner returned, max was covered in fleas, had not eaten anything in 5 days, and was still vomiting.

i ran preliminary bloodwork to find that max had a PCV of 70! to those not in the vet med world that's really really bad. PCV stands for packed cell volume and represents the percentage of blood that is made up of cells. normal should be between 35-45. 70% meant that this dog's blood was practically syrup. this was confirmed by a visual inspection of the tubes in which we spun the blood - it was chocolate brown and thick. a PCV of 70 represents severe dehydration. i talked to the owner about further diagnostics: bloodwork and xrays. she consented. as i waited for the bloodwork, we placed a catheter and started to slowly administer fluids to correct the severe dehydration. max developed head tremors. i stopped the fluids, the head tremors resolved. i started the fluids again, the head tremors returned. not a good sign by any stretch.

sighing at the impossibility of stabilizing him without causing neurological damage, i consulted my bloodwork. his electrolytes (sodium, potassium, and chloride) were so low as to be at the very end limit of the bottom of our scale. his potassium was 1.9 (life threatening is generally considered to be less than 2). his massive electrolyte imbalances explained the development of head tremors with fluids. then the xrays confirmed my worst fears. the stomach was completely filled with a mass of gorilla glue.

gorilla glue is an interesting substance. it's a poor glue for anything harder than wood. but wood it does well for because it fills in the gaps. it's not an epoxy glue, but a polyurethane adhesive. when it gets wet - it swells to approximately 10-15 times its original size. and that's what happened in max's belly. the good news is that it's not "sticky" per se inside the body. it forms a giant mass, but it doesn't adhere to anything. rather like a big rubber ball. there was a chance that - despite the duration of his illness - max's stomach was still ok. after all - stomachs are made to stretch. i checked his lactate (a measure of blood supply to organs) and it was within the normal limit, which gave me hope that the stomach wasn't dying due to obstruction and stretching.

i discussed all this with the owner - emphasizing first and foremost that stabilizing max would take hours and hours before we could even consider surgery. he was incredibly critical, his electrolytes so out of whack as to be life-threatening. the owner - distraught and confused and quite possibly under the influence of some sort of drug (based on her extremely pinpoint pupils and very erratic behavior, including yelling at the technicians) - elected to go ahead with stabilization and possible surgery, despite the $1600-2500 quote i gave her.

back i went to max, attempting to slowly re-hydrate him, despite the head tremors. and then the owner snapped, insisting on euthanasia. after talking with her some more, she signed the euthanasia form. i walked her to the front desk and returned to do my sad duty to the cute little puppy.

and the woman walked out without paying.

max went to heaven at my hands. after he passed, i opened his abdomen and exteriorized his incredibly massive, hard stomach. the stomach itself still looked viable, still had a good blood supply. i excised into it and removed the 1.5lb mass of rubbery gorilla glue. all in all - a sad end to a day that wound up being slightly in excess of 17 hours.

Thursday, June 19, 2008

holy first two days, batman!

i walked in at 6:30 tuesday evening and was handed a file. "patient in room 4," i was informed, "chewed and swallowed LARGE pill-cutter, complete with 2 razor blades sometime 12 hours ago." i looked at the radiographs from the referring veterinarian. uh-oh. 2 blades in the massively distended stomach.

the owner, a kindly, late 40s man, grasped my hand and admonished me to save his dog. said dog was a 9 year old (friendly - believe it or not) cocker spaniel with the most disgusting skin that i have ever seen (which is saying a lot for a cocker spaniel - they all come complete with gross skin, ears, and eyes). pimples, yeast, short - your average cocker. said cocker appeared to be feeling fine. i triaged - got her back to the techs to start getting in a catheter, drawing blood, and prepping for surgery.

i tried to find a quiet closet in which to hyperventilate. i was about to do an abdominal surgery. a REAL abdominal surgery. and that wasn't all. while that patient was being prepared, i was to see other patients. while she was in preparation, i took in a german shepherd with an extremely odd presentation (more on that later), a dog in respiratory distress with a heart murmur, a stepped-on puppy, a seizuring cat (definitely more on that later), a straining to urinate female cat, a humane society hit by car...and more.

meanwhile, the extremely talented technicians were battling to place a catheter in the disgusting, thick, mucoid skin of my cocker spaniel. surgery was supposed to be around 8pm. however - by the time the catheter was in, pre-anesthetic bloodwork was conducted, and we were ready to go, it was 11:30. my other patients were settled, and so in i went.

i was supervised by my attending clinician - but the surgery was up to me. and of course it couldn't be a simple foreign body removal. nope - not my first. it had to be spectacular. i exteriorized the stomach, gently palpating the bloated sac. i instructed an orogastric tube to be placed so that the material in the stomach could be removed. gentle palpation revealed masses of plastic. good - i knew where some of the pill-cutter was. i moved down the GI tract, softly squeezing and slipping the intestines through my hand. at the junction between the ileum and cecum (small intestine), i hit pay dirt. a huge wad of plastic - jagged and sharp - lodged there. i continued to palpate and to my immense dismay also found plastic in the colon. the colon is a nasty organ. surgery is absolutely avoided in that area whenever possible because of the poor healing associated with that part of the intestines.

sighing, i returned to the stomach. i made a small incision in the middle of the body and went to work removing the incredibly jagged plastic. but i couldn't find the razor blades. after suctioning and lavaging the stomach and feeling around more and having dr G feel around more, we decided they must have passed into the intestines. we closed the stomach and moved to the intestines. the mass located at the cecum was absolutely torturous. after incising the small bowel, i spent 20 minutes removing all of the plastic. the good news was that the bowel was healthy and pink - no sign of devitalized tissue. yet. and razor blades.

and then the colon. dr G suggested an ingenious idea. we used extremely long forceps (with an equally extremely long name that i have since forgotten) and had an unlucky extern remove the plastic rectally. and razor blades.

we were at a loss. it seemed unlikely the dog had passed the blades. the referring vet had taken the xrays a mere 1 hour before we saw the dog. the owner was very vigilant. so - by all appearances - the blades were still in the dog. dr G whipstitched the linea for me, and we took our patient to radiology. xrays revealed the razor blades.......................still sitting in the stomach. sighing with frustration - at hour 2 of surgery - back i went. i re-opened the linea, stared at the stomach for a moment, and then make an executive decision. my incision this time was 10cm. lavaging lavaging lavaging - and then - the razor blades made their much longed for appearance.

i closed the gastrotomy site and sighed with relief. 45 minutes later, the patient was recovering. and then...badness. her abdomen started to swell. i took a sample, and it was bloody fluid. ack. fearful that she had perforated a gut or that one of the enterotomy sites was leaking, i looked at the sample under the microscope. no bacteria. whew. over the last day and a half, she has been slowly improving. this morning, we offered her a tiny bit of bland stomach diet. and she wolfed it down. when i relayed this information to her extremely worried owner, i was engulfed in a minute and a half long, very soggy (as he was crying) hug.

and that - folks - was ONE of the myriad cases i handled on tuesday night - my first night as a veterinarian. more to come later on the other interesting cases i saw.

Tuesday, June 17, 2008


ok people - after talking to my mother and reading the comment left on "oh heavenly day" - i see that i have hurt some people's delicate feelings. there's nothing wrong with reading romance novels and christian books. i wasn't insinuating that there was. i was merely stating that i'm afraid that i'll mellow too much with age and lose the person i am in favor of becoming someone i feel obligated to be (but don't really want to be). it's not a criticism of anyone that i don't want to read romance novels or christian books or watch G or PG movies. so stop taking it that way.

psychosomatically ill

i feel queasy. last night, i didn't want my dinner. i only ate half of my homemade turkey breast salad with macaroni and nuts before i threw the rest down the garbage disposal. today, i cooked tuna melts and fries. and i couldn't eat a whole (small) sandwich. my entire GI tract feels loose and watery. it's been 2.5 months since i did any small animal medicine. and tonight - oh tonight - i'm on emergency medicine.

ugh. and i dreamt of tornadoes the other night. when i was younger, i had a deathly fear of tornadoes (we were in one when i was 8 or so). i've somewhat overcome that fear, although storms still frighten me more than the average person. at any rate, whenever i'm truly worried about something - i dream of tornadoes. the proximity of the tornado is always directly proportional to how close the worrisome event is. in my dream on sunday, the tornado was right on top of me.

**blech** i need to vomit.

Monday, June 16, 2008

we now return you to our regularly scheduled broadcasting...

i called my new boss last night and told her that i was 1) suicidally bored now that moving in was accomplished and 2) that veterinary knowledge was leaking out of my head daily.

thus, i start my internship tomorrow evening at 6:30pm. i'm working the overnight emergency shift.

Sunday, June 15, 2008

oh heavenly day

i'm not even sure that anyone reads this blog anymore, but hey -- it's really all about me anyway, right?

so - after living here a week, jim and i ventured forth into the heart of our new city. and i love it! downtown chattanooga is a beautiful place. there are 2 downtowns - in a way - one on our side of the tennessee river, one on the other side. the river is spanned by 2 large driving bridges and one very large walking bridge. it's a trestle bridge with a sunken middle, so i suspect it was once a railroad bridge. the view is lovely - you can see the hunter museum hanging off of the bluffs, coolidge park on the banks, and the island in the middle.

i can't get over the art scene in chattanooga. it has one! the beautiful hunter museum hangs on the edges of the limestone bluff overlooking the chattanooga river. surrounding it are many more smaller galleries, cafes, and inns. there is also a sculpture garden positioned on the top of one of the bluffs. most of it was modern art - and therefore not my taste - but there was one quite arresting sculpture of icarus. it's icarus, on his tiptoes, straining upwards, hands secured to his foolish wings. the sculpture is almost parallel with the ground, and it's positioned at the very edge of the bluff - as if - at any moment - it might take flight. i must say i was quite enamored of it.

we ate a local pizza joint called lupi's and were quite happy with the quality of our food. we also cruised around the famous tennessee aquarium. we didn't go in - but the landscaping outside is like a tour in itself. it's beautifully done - streams are built into the sidewalk. they're incorporated to look like part of the sidewalk itself was washed away by the stream's exuberance. in one area, a fountain spurts straight out of the ground. at that point, the pavement is pushed up and fractured, as if the fountain blew straight through it. there were kids in bathing suits everywhere, playing in the fountain. the whole air was one of festivity and joy in the summer day. not to mention that it was a truly gorgeous mid-june day. hot but not too hot, humidity within a tolerable range, and a hard, blue sky. there was a strong breeze off the river - and it was just ... lovely.

after eating, we roamed some of downtown on our side of the river -visiting art galleries and eclectic shops full of locally crafted jewelry, artwork, and the like. we found a great used bookstore - and it was there that the thrill of my day occurred. carol and barbara. barbara was in her 60s, carol in her 50s. they were funny, interesting, and they liked the sorts of movie and books and music that i do. "there will be blood" "no country for old men" - they discussed these movies with vivacity and genuine interest. and they told me about their book club - which is currently reading cormac mccarthy's "the road." i'll be joining them on the last monday of this month - and i couldn't be more excited. people with my interests! people who like the books and movies i do! people i can relate to in chattanooga. it was also heartening to see older women whose interest in independent films and culture and books and art hadn't slackened with age. i'm always afraid - on some level - that when i'm 60, i'll take to reading books like romance novels and christian stuff, and watching G and PG rated movies. it seems that taste must age like everything else and that i'll lose mine as i grow older. these women gave me new hope for myself.

all in all, it was a lovely day.

Wednesday, June 11, 2008

ahhh...the luxuries of "summer"

today was unbridled cat chaos. i was convinced that my incredibly obese orange tabby (chicken biscuit) had diabetes. he seemed to be urinating more (or someone using the litterbox is) - and he urinated in his carrier on the way from kville to here - which is a mere 2 hours. i suspected he was PU/PD (polyuric/polydipsic = more peeing, more drinking). so i took him to my new workplace - although i haven't started yet - and drew blood. i thought - in my infinite wisdom that i would also take along archie, my other obese cat and shave him. our collective allergies have been acting up, so cat grooming of my 2 biggest shedders seemed like a good idea.

i started by drawing blood from biscuit, which went well. he was very calm and we obtained the blood rapidly. when we went to draw a cystocentesis (needle stick through the abdomen into the bladder) - it took FOUR of us and an ultrasound probe to hit his bladder. not because he was squirming or behaving badly, on the contrary, he was wonderfully still. it was just that his bladder was buried beneath 6 inches of abdominal fat. i tried, the tech tried, another intern tried, and then the internal medicine specialist finally got it. all of this only to find out that biscuit - despite his massive obesity - is the picture of health - at least blood and urine-wise.

on to the shaving. i started with archie - to let biscuit have a rest. i decided to use ketamine and valium in combo - which should give you a reliable 45 minute sedation period. not to be not to be!! archie came out of the ket/val haze rapidly - necessitating gassing him down with isoflurane. he didn't like that and much struggling ensued. i got so frustrated, i essentially gave up. it didn't help that i was using surgical clippers with no guard on the blade = a very, very precise, very CLOSE shave. archie looks like a blind barber with a dull chainsaw cut his hair. i'd post pictures but i can't find the camera battery charger - and truthfully, it's too damned embarrassing. i hosed him off and stuck him back in the carrier.

for biscuit, i tried a different tact - domitor, torb, and ketamine at 0.1mL each. it was the best kitty cocktail ever. he was totally out of it - and i could shave him without too much trouble. he looks infinitely more presentable than archie, although he still looks funny (thanks to the surgical blades). and i had to gas him a little at the end, but all in all - it was much smoother than the first shave. if i hadn't already given archie drugs and iso, i probably would have re-dosed him and tried to smooth out his rough hair job.

no more cat grooming for a while.

otherwise, i am loving this new house and my freedom. new houses always start out so pristinely clean. and the landlord did a beautiful job before we moved in - he painted everything, put up new (nice) curtain rod and curtains...the house looks phenomenal. and my days are so languid. i sleep until about 10:30 am, make lunch, read my book, study some veterinary medicine (today it was immunology - which i badly needed a refresher of - and immune-mediated hemolytic anemia), nap occasionally, fix something yummy for dinner, watch a movie with the husband (alternately - we play tekken tag on the playstation), and go to bed around 1:30am. i love it. it's like being a stay-at-home mom. you know - without the kids. or actual work. or actual responsibility. ok, really it's like being a kept woman. without the bonbons or soap operas.

Sunday, June 8, 2008

boxed chaos

that's how the new house was yesterday. today, we are 90% unpacked. even pictures are hung. i can't get over how fantastic this new house is. to start with - it's absolutely huge. it's got an open floor plan, the bedrooms are large, and it has a room that is a converted garage big enough to be a double study plus have room for the queen size air mattress (for guests that won't fit in our new, super-duper guest room). i love it.

Tuesday, June 3, 2008

cake makes you fat. who knew?

i.................................hate..............................packing. my apologies for the largely incoherent post to follow.

i was fairly useless/unproductive yesterday. first day of my period. and we all know full well what that means. lots of sleeping and popping pills q 6 hours. (q = every - it's a medical abbreviation). i don't know how i'm going to be expected to function in the real world when the first day is always so awful. it's not just the cramps and non-stop heavy bleeding - it's the weird exhaustion and hormonal fog that descends over me. i truly cannot think clearly. and i fall asleep at the drop of the hat, even if well-rested. in vet school, i could skip class- no big deal. in clinics, if it was bad enough, i took the day off. i'm useless when it's like this. but in the real can i function??

anyway, i wasn't totally useless. i called the electrical co. (both of them), got our cable internet service set up, added the mercedes to the insurance, that sort of thing. i even did a little packing. but today, i've been much, much more productive. i'm sitting in the (mostly) barren study right now. besides my husband's desk/computer and my small table/computer, the room is empty. i took apart my desk today and moved all the bookshelves out into the dining room for easy loading.

we're picking up the uhaul on friday morning. saturday, we will head to chatty with alison, dee, and my brother. and then we're gone from here. it makes me sad and excited all at once. i love this area of tennessee. i've lived here for the past 7.5 years. the majority of my married life. i'm comfortable here. i know all the good places to eat, all the good music venues, the fun clubs, the good bookstores. and now i'm heading to a totally new town where i know nothing. on the bright side, one of my classmates that i actually like a great deal is doing the internship with me - i kind of got her a position there. there are also quite a few of my classmates moving to chatty - so i suppose i'll know some people.

just a sidenote: cake makes you fat. since i've been cooking fiendishly, i've also been making cakes. vanilla with chocolate icing, chocolate with vanilla icing, red velvet with cream cheese icing. jim and i were near a scale the other day - and we've both gained about 10 lbs. it's ridiculous. there's a moratorium on cake around here. but not ice cream. never ice cream.

Monday, June 2, 2008

I'm goin' down that river, I'm goin-a take da right hand road...

this weekend brought an impromptu trip to asheville our way. i figured - hey! why pack and clean and get ready to move in 3ish days when i can gallivant off to another state?? it started out when i saw that the hellsayers, a favorite, super-obscure (as in unsigned) band, were playing at a new club in asheville. since all of jim's kayaking buddies are there - i suggested we see the show and crash with them afterwards. he acquiesced, after some convincing.

once there, he was of good cheer. we went out to dinner at pizza brew with luke, lucinda, and jeff (all friends of the kayaking persuasion - but also just good friends). we passed the early evening eating pizza, drinking beer, and otherwise amusing ourselves. around 10:30, jim and i excused ourselves and went to the rocket club for the show. it wasn't too shabby. not the best live performance ever, but it was enjoyable. we made it in around 2:00am, and crawled into bed.

the next morning, we spoiled ourselves with brunch at sunny point cafe - a fantastic, trendy, hippie spot in asheville (aren't they all??). i had stuffed french toast, jim went conservative with the huevos rancheros. afterwards, we all piled into the car for a kayaking trip down the french broad.

now -the french broad is a class III river. not all the rapids are III, there are quite a few class II. but i can't roll yet in a kayak - so once i flip - i'm coming out of the boat. swimming sucks. you lose your boat, so other people have to round it up for you. you sometimes drop your paddle, which someone else has to round up. sometimes you wind up in the middle of the river, stranded on a rock - considering your options for swimming the rapids to the shore/nearest eddy. despite my nervousness, i was surrounded by confident paddlers (everyone above, plus a friend named paul). i ran the first 2/3rd of the river without any problems - no flipping. it was after the hardest rapid on the river that i had my first mishap. i'd made it through the rapid itself with no problem. it was a nifty little rapid - down a small slide/waterfall, with a sharp turn to the right and down a little chute between 2 rocks. i did it beautifully. and then, i turned around at the bottom to look and gloat and plop ! over i went. **sigh** after that, i swam 2 more times, once for no good reason, once in a class III wave that was quite large. after the 3rd time swimming, i felt bad that everyone had to help me retrieve my boat, empty the water, blah blah - although no one seemed to mind in the slightest - so i elected to let jeff take my kayak, and i joined his girlfriend holly in the duckie with the beer.

i had a very good time. i can see the allure of kayaking, but it doesn't hold the excitement for me that rock climbing does. maybe because i'm nervous the whole time - or maybe because i can't roll my kayak yet. i'll probably try it a few more times and see how i do - if i can get the roll down. i'm sure jim can teach me, he's a pro - after all.

and now, we're back to the real world. calling the electric company, the cable internet company, the landlord...packing, cleaning, and moaning. in 3 days, we move away.