Happy Gobble Day!!

i sincerely hope that everyone finds a happy place to be today. i am reminded how lucky i am to have not one but two families. we had 2 thanksgiving dinners, played some football, and are now spending time visiting.

i am truly lucky in my life...well...other than the fact that i have a cut in my mouth where i ran into a tree while playing football and 2 maybe broken toes where i was stepped on while playing football and a big bruise on my stomach from where my brother accidentally kicked me while playing football.......and i'm about to slip into a turkey-induced coma too...

GOBBLE TILL YOU WOBBLE!

kidneys on the brain...

on a terrible, crazy, non-stop, panicked sunday, a small fluffy rust colored poodle puppy came my way. he weighed a mere 4lbs 13oz. he had the great misfortune of being picked up and crunched on by a much larger dog.

when i examined him, he was quiet but alert. he even wagged his very fluffy stumplet of a tail. i'm not a poodle fan, but this guy was ridiculously cute. he looked pretty stable, was walking and alert. i found a small hernia on the left side of his body and a giant hematoma (blood clot), but it didn't feel like organs were in the hernia. i had concluded he was stable and was about to turn to a more critical case (1 of MANY MANY cases that day), when it occurred to me that i had forgotten to check his mucus membranes. i rolled back his lip and HELLO! his gums were paper-white. i checked his abdomen quickly with the ultrasound probe, and sure enough - his abdomen was full of blood. sickened, i went to deliver the news to his incredibly sweet parents who had lost their other poodle to kidney failure a mere month beforehand.

we opted for immediate surgery to identify the cause of the bleeding and to fix the hernia.

when i opened the little guy, i was prepared. this wasn't going to be like my last, god-awful hernia surgery. as soon as the abdomen was open, my assistant started removing the blood for auto-transfusion. when the abodmen was semi-cleared, i looked for the source of the bleeding. it was fairly easy to find. the left kidney was hamburger meat. the renal artery (which is a direct offshoot of the aorta) was partially torn away from the kidney and bleeding profusely into the abdomen. the kidney itself was fractured in half.

i didn't mess around but began ligating the renal artery and vein, as well as the ureter so that i could remove the kidney and stop the bleeding. when you weigh 4lbs, even a little blood loss is significant. this guy had 50 milliliters of blood in his abdomen when i started.

we fought for this guy. i tied off everything that bled that wasn't supposed to do so. i removed the kidney, i flushed the abdomen. i checked for bleeding obsessively. nothing.

we closed him, and i almost prayed.

2 hours later, he bled to death internally. likely due to the extensive amount of fluids he received to maintain his blood pressure (blood products, hetastarch, normosol-R). was it my fault?

i will never know for sure. i had my attending clinician glove in at the end and check to make sure she could find no other sources of bleeding, and she could not. she gave me the all clear, gloved out, and i closed. after surgery, his blood pressure spiked (due to the fluids/blood transfusions), and it's possible that he began to bleed from the vessels that i tied off. it's also possible that he had a tear in his aorta somewhere that i couldn't see or that i didn't completely tie off some unusual branches of the renal artery.

his parents sobbed, but they told me how grateful they were for my services. they were incredibly kind, and it broke my heart.

in the end, i know that i worked as hard as i could, was absolutely meticulous, and realize that this guy underwent a terrible trauma. i did what i could to save him.

was it enough? will it ever be enough?

sigh

i think i neglected to mention that both of my surgeries died in the post-operative period. not from anything i did or didn't do (that i know of) - but because the nature of their respective conditions was so severe that their chances going in were very poor.

still, it didn't make for a good weekend AT ALL.

now i'm off for 5 days, headed home for thanksgiving and the 30th wedding anniversary party i'm throwing for my parents. i'm sure i'll post more details about my surgical experiences soon.

there are no words. or at least, only a few words.

omigod. there is nothing to say about this weekend other than this:

i did my first GDV / splenectomy surgery BY MYSELF (no attending clinician) followed today by my first NEPHRECTOMY BY MYSELF. big dog little dog attack, fractured kidney, partially torn renal artery (which comes off the aorta - the biggest blood vessel in the body), tons of blood in the abdomen. it was SOOOOO much fun. and by fun, i mean awful, terrifying, and in the end, fruitless.

i will elaborate at another date, but for now...OMIGOD.

**ps: nephrectomy = kidney removal

how i became the homeless parrot redux

for beloved parrot - a repost of a previous explanation of how i became the homeless parrot (on my original part 2 blog, which i took down several months ago)


someone asked me the other day what the title of my blog means. and while i'm a total fan of individual interpretations...being a lover of novels and poetry and music and such...i thought i'd explain. however, if my explanation doesn't jibe with yours, then by all means, continue to believe what you originally thought. everything has different levels of meaning, eh?

while an undergraduate, i decided veterinary medicine was what i wanted to do with my life. to that end, i took courses designed for med/vet students. however, during my junior year, i became concerned that veterinary medicine was a selfish career choice. it would take 4 years post-graduation and eat into the time during which i could be having children and building a family -something i'd always wanted to do. vet school would also be an enormous financial and emotional burden. i decided - after lengthy consideration - vet school wasn't for me. i finished a degree in biology, but i was short a few pre-reqs for vet school (organic II and biochem, physics, notably).

after graduation, i spent a year completely lost. floating along, trying to decide where my life would lead me. nothing made me happy. i applied to various graduate programs - microbiology, evolutionary biology, even the masters in teaching. but nothing felt right. i was intensely unhappy during that year - dissatisfied with my lack of direction. after graduation, i worked as a riding instructor at a YMCA camp for a summer (which i absolutely loved) and then as a veterinary technician (which i loved, too). i moved on from that to a job in a human medical office that offered health insurance and which i absolutely and totally hated and actually wound up walking out on. i made it 6 months there before moving on to a job in the business office of a physical therapy center.

one day, i went with a friend to pick up my landlord's sick horse from the vet school. i stepped inside the building and was overwhelmed by a sudden sense of absolute belonging. of coming home. of being exactly where i was supposed to be. i cannot begin to describe it. if i believed in the divine, then i would believe that the moment was a sign from above. when i left, i knew that i had to do it. there was nothing else.

i enrolled in organic II and physics at a local community college and spent the next year working on finishing my pre-reqs and going through the rigorous process of applying to veterinary school. most candidates apply to multiple schools. i put all my eggs in one basket, mainly because hubby was already enrolled in his graduate program, and hoped against hope that i would be one of the few selected. and here i am, near the end of this leg of my journey. sometimes it all seems too surreal to be true, as if this is my dreaming life and my waking life is false.

i suppose a more appropriate name for this blog would be the homed parrot. but before i found vet school, my soul was homeless. and now i've found that thing which makes me happier than anything else. for all the toil, the sorrow, the burden, the hours and hours of work and studying, the damage it's done to my mental stability and that of my husband, i know that i am where i belong. there is nothing else that would have sufficed. my only sadness is that one day i will be too old to be a veterinarian anymore.

tired...

good times today. long though...

actually - i did have a rather good day. i was woken up at 7am (rather than 7:45) by my phone ringing. it was a neighbor 4 houses down who had maybe found my cat. despite the fact that she called me at SEVEN A.M. - i was thrilled. and it was - indeed- bruiser she had found. he'd been hanging out with a gaggle of outdoor cats in the yard next door. i was grateful - but i did NOT mention that i am a veterinarian to her, since i saw that she had a dog.

at work, we did 2 dog neuters, 1 dog spay, 1 cat spay, and a declaw (ick). it was nice working with the senior students. they all did well, were pleasant to work with and helpful. it took us all of 10 hours to do those simple surgeries, but i was okay with that...other than the fact that i didn't pee for 12 hours. and the fact that the last surgery of the day was a declaw - which i absolutely hate to do.

afterwards, i grabbed some dinner with a classmate who works at a nearby vet clinic, an extern currently at my place of employment, and the husband.

now, i'm wiped. it's time for bed, because the weekend is here. and the weekends are hell!

hi-ho hi-ho...it's off to work i go...

tomorrow, i return to work for a four day stint. our schedule is very strange. when we're on days - we typically work 7-8 days in a row. then we have 3-4 days off, then we go back and work the noon to midnight weekend shift (which is friday through monday).

i'm on the four day weekend shift this time around. tomorrow, the orthopedic service from my alma mater comes up and does orthopedic surgery and sees referral appointments. they bring along the current seniors (class of 2009) and they do spays/neuters/declaws/etc while the orthopod does surgery. the noon to midnight intern is in charge (so it's really 9am till midnight - except i think i finish when the senior students finish, so i could conceivably leave as early as 5pm).

WTF?

long story short: i brought home a black cat from work to live outdoors at my house. he was unceremoniously dumped at our clinic by his white-trash owners (sorry, but it's true). he was a GREAT cat, and i fell in love with him in a weeks' time. we were introducing him to the backyard, and he was outside, when my mom called to tell me that dad was having a heart attack. we tried to find him to no avail. rather than continuing to search, the husband and i left for our 4 hour drive to the hospital. i haven't seen the cat since, which makes me feel like a terrible vet and person. i've driven round the neighborhood, posted signs, called the shelter, checked online - nothing.

i'm not generally an advocate of outdoor cats - i've seen far too many dog maulings, hit by cars, malicious abuse, FIV + cats to ever want my cats to have to suffer something like that. yet, i didn't want this guy to go to the shelter and possibly get euthanized (and he was already an outdoor cat), so i brought him home to be outdoors (we currently have 5 indoor cats - which borders on crazy). he was bar none one of the sweetest, most pliable cats i have ever met. and he liked to hug you!

he's been gone since saturday and naturally, i feel rotten. NOT the best week ever. i posted fliers yesterday with my name (first only) and phone number. thank god, not my address- as it turns out.

my phone rang this afternoon. the conversation went something like this:

me: hello?
crazy woman: yeah, i was calling about the black cat. where did you get him??
me: umm...what?
CW: where did you get him? the cat?? where did you get him, huh??
me: i'm a vet (mistake number 1) and someone dumped him at my workplace.
CW: you're a vet? oh so somebody abandoned him?
me: yes.
CW: i just wanted to tell you that there are mean people in this neighborhood. they steal cats. of course, they steal mine because i 'm single. but they steal them and they take them to the smiths' house. only smith isn't the girl's maiden name, it's mcgammon or something.
me: ooookay.
CW: so like i said, there are mean people in this neighborhood. they collect cats. they might have stolen yours.
me: okay, so you're not calling because you found my cat?
CW: no, bvt i do have one that looks like that. he hangs out at the house behind me now though - that's the brown's house. but i know he's there. he just hangs out there. you know - there are people in this neighborhood that steal my cats because i'm single.
me: ok - will you just keep an eye out for my cat?
CW: hey, could you vaccinate my cats for free for me?
me: umm, i work in an ER clinic and don't currently have access to vaccines.
CW: oh. ok. do you know the smiths? they steal cats. i think it's because they're poor. they're not too poor, but they are a little poor.
me: umm, i have to go.
CW: hey, could you come to my house and vaccinate my cats and just send me a bill?
me: i work for an ER clinic, and we don't do vaccines.
CW: oh...so you work at the **insert the name of my workplace here**?
me: ummm yes (likely mistake number 2), ok, i have to go now.
CW: oh. ok. are you sure you can't vaccinate my cats?
me: HANGING UP.

don't worry, she called back a mere 25 minutes later. i recognized the number and didn't answer, but i had this message waiting for me on my voicemail: "hey, i was just wondering if you have any coupons for free animal food, since you're a vet - and if you maybe wanted to share them with me."

cause after all, i am a vet.

who is john galt?

so 'the last days of dogtown' has been moved to the back burner, and i'm taking another run at my personal literary everest...'atlas shrugged.' once upon a time, 'the fountainhead' was my literary everest. it took me 5 attempts - the first four, i couldn't make it past the first 30 pages or so. on the fifth try, i became totally and completely immersed and burned through the book in no time (relatively). so far, i'm riveted, naturally. ayn rand is nothing if not compelling. should i finish it this time, i will have to find another literary everest. oh wait. i already have one: the gormenghast trilogies...

insert segue here:

when we went to the avett bros concert back a bit ago (2 weeks?) - i came in at the tail end of the opening band. the bijou is the ONLY venue that runs on time, in my experience. when it says "show starts at 8pm" - well then - the opening band is on at 8pm dammit. so, we missed 98% of the opening band. i got to hear the end of the song "i will be released" by matt butcher and the revolvers. i was very sad to have missed them - because - from what i can tell, the music is great. so check them out:

http://www.myspace.com/mattbutchermusic

you can also see the stuff from knoxville on youtube, if you just type in avett brothers knoxville - it will bring up the matt butcher stuff, too.

my dad

my dad is home already and expected to make a full recovery. he is going to be on plavix and low-dose aspirin for the rest of his life, it seems. i see it as a good thing - because hopefully his life will now be much longer, since we know what his biggest health problem is. thanks for all the thoughts, prayers, emails, phone calls, and text messages. it meant a lot to me.

crushing defeat...yet again

when i came on the day shift monday, a case was transferred to me that had been hospitalized for the weekend. max was a 1 year old, beautiful boxer. he was absolutely stunningly gorgeous, and he was sweet to boot. he and his sister dog had decided it would be a good idea to raid mom and dad's medicine cabinet. during the raid - an enormous quantity of naproxen and advil was consumed. the toxic dose of naproxen in dogs is VERY low - something like 5 milligrams / kilogram. max had ingested about 50-100 times that amount.

he was treated at his veterinarian with decontamination (induced vomiting, activated charcoal to absorb toxins in the stomach, hospitalization, and monitoring). his sister did well, but he developed SEVERE bleeding in his GI tract. this isn't surprising, since NSAIDs (non-steroidal anti-inflammatory drugs) inhibit the production of prostaglandins in the body. when you have a headache or muscle ache, this is a good thing, because some prostaglandins promote inflammation. unfortunately, there are good prostaglandins, too - and these are also inhibited by NSAIDs. these good PGs help keep the gastric mucosa healthy and the acid level normal. when you inhibit them, the stomach and upper small intestine have problems with the normal coating, and GI ulcers occur. this is why you have to be cautious when taking NSAIDs. too many can lead to stomach and duodenal ulcers. the biggest concern in these severe cases is that the area of ulcerated mucosa will eventually rupture, leading to perforation of the GI and spillage of the intestinal contents into the abdomen (septic abdomen = BAD).

max started to have extremely black stools - full of digested blood from his ulcerated stomach and GI. he was depressed, and he didn't want to eat. we managed him aggressively, but his PCV (packed cell volume) continued to drop, as he lost massive quantities of blood into his intestines. his albumin (a critical protein in the body) also dropped precipitously, because - again - he was losing it in his blood through the ulcers.

we supported him with GI protectants out the wazoo (pepcid, prilosec, carafate) and misoprostol - a medication that is a mimic of prostaglandins made by the body, but his biggest problem was his falling PCV and albumin. i made the decision on wednesday to transfuse him. transfusion won't bring the proteins up much - you need massive quantities of albumin to do that, but it would help his PCV. in total, he received 1 unit of packed red blood cells, 2 units of fresh frozen plasma, and 450mL of whole blood from a donor.

and he bounced back. his appetite and attitude improved, his PCV hovered around 26% (as opposed to 15%), and he started wagging his stump again. i made plans with his owners to send him home on thursday.

and then...from the jaws of victory, defeat was snatched. he spiked a fever of 105. his PCV dropped from 26% to 18% then to 16%. he turned yellow. his liver values went off the chart high - and i mean high (for vet people - his ALT was 6500!!). 24 hours after his transfusions, he was suffering a delayed reaction to the blood products. his body started to destroy all of that blood we had pumped into him. even worse, he went into acute liver failure.

on saturday, i wasn't with him, caring for him as i was supposed to be. his PCV dropped to 12%, and he collapsed and began to have difficulty breathing.

his owners - invested emotionally and financially ($4000!) were crushed, i'm told - as the final decision to euthanize him was made. i spent a week working with this guy, loved him, saw him improve dramatically, and allowed myself to hope that we had been able to undo some of the terrible damage to his GI tract - only to watch him suffer the most severe reaction to a transfusion possible.

chalk it up to another loss for the home team.

addendum: i just noticed that all of my work posts are depressing...i promise that the next story i tell will have a happy ending. problem is - i have to come up with an interesting case that ended well. it's a dilemma - because if it's interesting enough to write about - the outcome probably wasn't good.

my dad had a heart attack this morning. he was taken to the ER about 30 minutes after the onset of the chest pain. they treated him with thrombolytic drugs to break up any clots and sent him in an ambulance to the nearest referral center. he underwent a cardiac catheterization which confirmed a blood clot in the coronary vessels (not sure if artery or vein). the thrombolytic was successful in breaking the clot down, but the degree of myocardial (heart muscle) damage is unknown at this point. he is in the ICU. we spent the day there with him. he is bright, alert, and aware of everything. we talked at length, and he is feeling okay. hopefully, he arrived at the hospital in time to absolutely minimize the damage.

he'll probably stay in ICU 1-2 days total, then maybe go home monday - depending on what they find on the echocardiogram tomorrow/monday.

it was not a good way to wake up this morning (at 6:30am to a phone call from my mom - who sounded oddly calm). this is the second time in 2.5 weeks i've had to miss work. first i was sick, now this. i'm starting to feel very unreliable.

keep my dad in your thoughts please!

ps ps

just spoke to my c-section dog's owner. all is well, and she is bouncing back amazingly.

i'm thrilled. and i'm home finally after 3 days away. i'm such a homebody that i miss my house that quickly. i love being with my best friend and her husband, but i love my house. i also miss the fluffies when i'm away.

i go back to work tomorrow, i'm on days (8am-8pm). i rather like days and can't complain.

ps

i have nothing veterinary to talk about because the last 2 nights i was working, i was in a sick, sick haze. i can't remember more than 1 patient - my c-section. i really want to find out how she did, i was terribly paranoid about her well-being post-operatively.

whoo

perhaps i will not see the avett bros when they go to my favorite venue. second best: i'll see band of horses on the husband's birthday in atlanta.

i can deal with that:)

sundries

i just attended my 4th avett brothers concert. they are so ridiculously, freakishly talented that i'm amazed anew every single time. this show was no exception. it was a bit of a departure from their other shows - they played more of their lesser known music and a great deal of newer stuff. it was also not all rompin' stompin' bluegrass like the last show. nonetheless, it was fantastic. they are becoming polished performers - but not in an obvious way.

i WAS really excited, because they're going to play one of the best venues within a 3 hour radius in december - the same place i saw them this time last year. unfortunately, i am scheduled to work.

sadness ensues.

ah well. perhaps one of my comrades will want new year's eve off work and will choose to swap a night with me...we shall see.

tomorrow is college football and homecoming. also - my sister-in-law's birthday, which we will celebrate with friends and family after our (presumed) football victory.

our head coach was fired. after 30 years at the school...he has been fired. i was all for it, until i saw the press conference and watched him visibly choked up by the loss of his job. on the other hand, he doesn't get paid millions and millions of dollars every year to lose 6 games!! still - it was bittersweet. i'm very interested to see what next season brings in terms of a new coach. i've been immersed in college football since my then boyfriend (now husband) introduced me to its previously dubious charms in 1997. ever since then, i'm a junkie.

as you might expect, this previous illness has not killed me - and i will live to see another horrendous head cold/flu bug/? the husband has the great misfortune of now being ill. i have the even greater misfortune of caring for him. (really, i'm kidding. he doesn't whine at all - not NEARLY as much as i do).

i promise to post something vaguely related to veterinary medicine again soon.

scattered, incoherent thoughts on the president elect

i'm sure everyone who follows my blog knows how depressed i am that we just elected an inexperienced senator from the chicago political machine to the highest political office in the land (a man whose idea of fixing our economic crisis is to "redistribute the wealth" b/c it worked so well for so many other socialist countries).

i was not a huge fan of bush. i was not and am still not a huge fan of mccain (he's conservative by a HAIRSBREADTH) - although i respect his experience and service to our country. i do not like obama most of all.

the election is over, and instead of looking at the bleak side of things...i am going to hope for the best. perhaps obama will choose his advisors wisely - looking to people that are in no way similar to his lifelong mentor and church leader, jeremiah wright.

i can only hope that this is the case. i want to be optimistic - and it sure beats looking ahead glumly.

this election also reminded me again that it is all a puppet show. a 2 party system in which the only candidates that could possibly afford to sustain a campaign are millionaires many times over (and consummate politicians) is no way to run a democracy dammit!! third party !! third party!! fourth party too!!

plato may have had a point with that whole republic idea.

welcome to the blogger world!

my mom has joined the blogging world:

http://redrobinlane-rgcarr.blogspot.com/

after almost a week, i'm still fairly sick and unhappy. we're still going back to the hometown for a concert on friday night (rompin' stompin' bluegrass) and homecoming football on saturday with a birthday dinner afterwards. all of these plans might go straight in the toilet because the husband woke up this morning full of snot. i coughed all night and kept both of us awake.

good times.

triple ugh.

ugh. i am sick. not the fun kind of sick where you only feel slightly bad - enough to justify lying prone on the couch and watching TV. nope, i'm the staggering around in a dayquil/nyquil induced fog cannot think straight want to sleep all the time fog. i feel awful. i would chalk this up to a bad head cold, except that both of my mandibular lymph nodes are swollen and painful. i don't think that typically goes along with your run-of-the-mill cold. but what do i know?? i'm an animal doctor. hee hee. i have lymphadenopathy. if i were a dog, i'd diagnose myself with probable lymphoma and aspirate my own lymph nodes.

ok that was the nyquil talking.

i missed friday and saturday night at work. it sucked. it made me feel like a total slacker. i never complain when i'm not at work, but i hate calling in because other people have to pick up my slack, obviously. i worked in a day clinic on saturday. i wasn't able to call in at that place, because i was the only doctor working and they were relying on me to be there. at least at my "real job" on the weekends there are 2 interns and 1 senior clinician.

i went in last night, and i was predictably miserable. plus, i had to do surgery - which super-duper sucked. i did a c-section. my first c-section, actually. i hope the dog is still doing well. i was very scared- mostly due to a) being so sick i couldn't think straight and b)the dog had HUMONGOID veins and arteries from being pregnant.

all 4 puppies survived. hooray. i laid down at 1:15am, sick, miserable, and foggy only to be awakened at 6:30am with a patient.

**sigh** i'm off tonight, for some odd reason - but i have to work tuesday night. if i haven't died.

ok, i'm going back to the couch to continue watching season 2 of gilmore girls.