odds and ends and where did you get your veterinary medical training??

so, since i got so many interested commenters on the whole lymphoma saga - here's the REST of the story:

i worked sunday with 2 vets pulling relef shifts for us. one of them was THE referring vet for that case. the boxer is still doing well. we are both perplexed and highly skeptical of the cytology report. if it is lymphoma, we'll know in about 1.5 months. not that spectacular of an ending, but so goes medicine.

in other news, i did an exploratory surgery on a 120lb dog that came into work on sunday collapsed with a PCV of 23 (packed cell volume = what percent of blood is cells versus plasma - normal is 35-45), and white gums. he was bleeding into his abdomen. i talked to the owners about the likelihood that he had a bleeding splenic tumor. we talked about prognosis for this, and they decided to do initial staging of the possible cancer (bloodwork and xrays), then if everything was clear - take him to surgery. the chest xrays were pristine, especially for an old dog. the bloodwork revealed dehydration and a VERY MILD elevation in ONE liver enzyme. all other liver enzymes, as well as liver function values were normal. the one enzyme that was elevated was about 1.5 times normal - which can be secondary to old age, dehydration, mild inflammation. it wasn't a value that i even glanced at twice. it was that benign and non-specific of a finding.

so to surgery we went. i suctioned about 4.5 liters of hemorrhage out of this dog. that's a MASSIVE amount of fluid. when i could finally see the liver, i was saddened to see that - despite normal testing - it was covered in metastatic cancer. the bleeding was coming from an angry looking mass on the caudate lobe. the spleen itself did not have a bleeding mass, but it did have masses all over it (benign or malignant could not be determined by looking). we euthanized on the table per the owners' decision.

i was satisfied with the job i had done. i knew i had gone to surgery and given the dog a chance. the outcome sucked, but i was happy with my performance. apparently, the owners were not. they called disputing their surgery bill, claiming that they shouldn't have to pay because the dog was no longer alive. they also claimed that i should have KNOWN that the liver was covered with metastatic cancer because of the EXTRAORDINARILY mild elevation in a liver enzyme (ALT - the value was 156 - the reference range is 0-80). despite the fact that all other liver enzymes and function was normal (even the clotting times were normal!), i should have intuitively KNOWN that the cancer was in the liver.

i spent 20 minutes on the phone with the female owner explaining as patiently as possible that despite the fact that her dog was euthanized, i still took 2 hours to do surgery, used THREE technicians to do it due to the extensive suctioning and bleeding, used suture, anesthesia, injectable medications, etc. i also tried to point out as tactfully as possible that if you go to the ER, receive emergency treatment, and die - then you're still responsible for the bill. surgery in a human hospital is no different. the expertise, materials, time, and staffing are the same - regardless the outcome. i also spent 10 minutes explaining bloodwork values to her, liver function versus liver damage, and what exactly ALT means and what such a minor elevation could indicate. i had to repeatedly resist the urge to ask her where she received her medical training?

she told me that she thought i "downplayed" the changes in the bloodwork and that they would have euthanized if they'd known what they knew now (AS WOULD I HAVE...OBVIOUSLY - HINDSIGHT IS FLAWLESS, but alas, my crystal ball and xray vision were on the fritz this week). she said that she felt that they were pressured to go to surgery.

the kicker?? she actually admitted to me the following piece of information: "maybe i watch too much grey's anatomy. you know - they're always dying to go to surgery on that show."

i almost screamed when i heard that. i resisted the urge and calmly informed her that i have NO financial or personal incentive to go to surgery, that i avoid surgery unless it is absolutely necessary, and that her dog had lost about 1/2 of his blood into his belly, and would have died on his own had we not done something (either surgery or euthanasia).

in the end, the owners were nice to me. unfortunately, i have the feeling i haven't heard the last of them.

we'll see.

hold on to your hats people...

i usually work 3 sundays out of 4 in a month. on those 3 sundays, i always wake up about an hour and a half before work. i lie in bed, and i think to myself how - at that moment, in that time - i don't hate my job, i don't hate myself, i don't hate people and the universe at large. i lie there and revel in that feeling - there in the pre-sunday calm.

sundays are unabashedly nighmare-ish at our clinic. we are the only ER clinic in this area, and we see a massive influx of animals in dire need of medical attention on sundays. i HATE sundays. i dread going to work on sundays and sundays alone.

today was .... hang on to your hats people ... NOT BAD.

i had a good day at work, despite 2 euthanasias. i was chipper, upbeat, and relaxed - in spite of having to go to surgery on a 120 pound dog with 4 liters (or more) of hemorrhage in his abdomen and despite putting down a small miniature pinscher that was out for his nightly walk and was mauled by a stray dog.

all that said - i still had a good day.

my last patient of the day was a bit of a mystery at first. a 7 lb mixed breed dog that presented for vomiting, lethargy, and "bruising." when i rolled his lip up, i was astounded to see that his gums were paper (and i'm talking PAPER) white. i went to get a blood sample with the tiniest needle imaginable, hit the vein on the first flawless stick, and watched in amazement as the vein began to blow and a huge hematoma spread under my needle. i took another look at the "bruising" and went to find my owners.

"any chance he got into rat poison?" i asked innocently.

the owner looked at me and with a straight face said, "oh no! absolutely not. well...now that you say it...we caught his brother with a mouth full of rat poison about a week ago and we made him throw it up...but his little guy...no, not possible."

so little puppy is getting himself a plasma transfusion (probably finishing it up as we speak), as well as some vitamin k to help him start clotting again. i hope he will do well, but we shall see. he was pretty anemic, too. thankfully, the owners gave their dog aspirin today because they thought he was painful. YES, i said ASPIRIN - as in the medication that causes "blood thinning" i.e. decreased clotting.

gotta love self-medicating owners!

the life and inanities contained therein

here are some non-veterinary tidbits...to lighten the mood a bit:

1) we dropped sprint like a hot potato. sure, i enjoy having no to 1 bars in my house at all times, as well as getting about 50% of my voicemail (where the other 50% goes is anyone's guess. the ether?)...but it was time for a switch. we are now with verizon. and yay, i got a new phone that i keep playing with (an EnV2). hopefully it'll be a few months before i drop it in a) the toilet b) a cup of coffee c) a large glass of water or d) throw it at the windshield in an absolute fit of PMS-induced rage

2) i gave up reading atlas shrugged for the time being. i'm about 250 pages in. i really like it, and i'm intrigued. i just can't bring myself to finish it. i did go back and finish reading 'the last days of dogtown' - which turned out to be fantastic and tear-inducing. i really enjoyed it. i was reminded of diamant's other book i read, 'the red tent.' it took me a bit to get into it, but it was incredibly rewarding. same with dogtown. i highly recommend it.

3) i'm a total and complete music snob. i like prog rock and obscure music. pandora.com has become my favorite internet music browser, and i buy independent music from emusic. i'm recently addicted to for against and interpol (they've been around a while). all that said, i can't help but admit that i'm totally infatuated with the new and totally idiotic britney spears song (womanizer) and pink's anti-marriage anthem (so what?). "yes, hello. my name is catherine. i have been clean and sober from terrible pop for all of 30 seconds. i'm back off the wagon." ***Sigh*** at least i own up to my problem.

4) i'm doing relief work next week at another local clinic (haven't been to this one yet). the pay is only $38/hr instead of the $45-50 i'm accustomed to...but i want to work, and i'm getting a new computer (YAY!), so i need to finance it.

5) the credit card is really and truly paid off. now our debt merely consists of student loans. merely. hahahahahahaha.

6) i've been firmly offered a position next year at my current place of work. i haven't decided what to do. one moment i'm squarely 100% committed to taking it. the next second, i'm totally against it. look for a pro/con list coming to a post near you soon.

7) the husband has been mistaken for the actor gale harold (jackson from desperate housewives) at least 3 times this week, including today at verizon. i've seen pictures, and the similarity is astounding and uncanny. we're trying to figure out how to use this to our advantage.

8) mike wasowski has become firmly entrenched in the household cat-ranking. apparently, she will be staying with us permanently. damn cute kittens. i think 5 cats borders on mentally unstable.

9) i got new perfume (in gel form) from my mom for xmas. i was thrilled, because it was the perfume i wanted. when i went to work, my boss and sometime mentor was also wearing the same perfume. thus, i used some xmas money to buy another perfume. the techs already refer to me as her "mini-me".

10) while home for xmas, i watched a BBC miniseries with my MIL called 'north & south' - it was ridiculously addictive and ridiculously good and rather like jane austen, with a twist.

i guess that's all here for the moment. look for more self-centered posts ... oh wait. they're all self-centered.

peace out, yo.

in the words of the teletubbies...BIG HUG.

as in, i need a big hug.

saturday was a nightmare from start to finish. the morning began with me oversleeping. i was rushing around, trying to put on makeup and look halfway decent when the full length mirror in the bathroom decided to fall onto my foot. it managed to hit the joint between my big toe and the rest of the tarsals. i screamed after the 10 second period of absolute numbness (that split second when you KNOW how bad it's going to hurt but it hasn't started hurting yet). i thought my foot was broken for sure. so first on the agenda at work - xray myself. thankfully, it looked ok - other than a horrible bruise and swelling. i just had to limp around all day.

it only got better from there. my 2nd case of the day was a 5lb fluffy dog that drank antifreeze. his owners' car blew its radiator. the dog was frolicking around and licked the fluid coming out from under the hood. by the time he got to us, he was already vomiting. the owners had NO money. not a single cent. they didn't even have the money to pay the $103 emergency fee. the female owner was on drugs of some sort - i'm not sure what - valium, oxycontin, some sort of downer. at any rate, we saw the dog about 4 hours after ingestion - which is still in that golden period when the antidote might work. problem? the antidote is $830 a bottle. what did i charge them in the end? $90. yup. i said $90 (the clinic pays about $300 for the bottle). i didn't even recoup expenses. i'll be interested to see how this turns out when i go back to work on thursday. maybe i won't have a job anymore. the kicker? the woman owner treated me like garbage - yelling loudly in the lobby about how unfair it was. after all, why should i expect money?

that was followed by an african grey in severe respiratory distress. she was a 21 year old bird that was well-loved by an elderly gentlemen. i worked on her like mad for 2.5 hours trying to save her, but in the end - i was no match for the disease process that had her in its grip. i had to euthanize her. it broke my heart in two pieces. mostly because i could see my own little fluffy grey bird in her.

on the heels of that came a little dog with an eye problem. i recognized the name as the dog i had done a conjunctival pedicle graft on months before (a delicate, difficult eye surgery). i was thrilled to see that when they followed up with ophthalmology - the ophthalmologists were impressed with the surgical technique. unfortunately, as i talked to the owner, it became clear that my surgery had failed, and it had been redone by another vet.

i finally made it out the door, depressed, distraught, and feeling like a failure - only to have to get up and do it all over again yesterday. sundays suck. yesterday was no exception. at the end of a 13 hour shift, i had to pack in a mad rush to drive 4 hours to our hometown so that we could celebrate christmas with my husband's family today.

the car trip was miserable. i was exhausted, had a migraine, and had to stop halfway so that i could vomit.

i have 2 more days off before i have to go back to work for 5 days - the christmas weekend. it promises to be hellish.

BLEH.

um.......quoi?

so remember how i had the patient that i "mis-diagnosed"? i sent the cytology out to the state lab, and they agreed with my diagnosis of lymphoma.

now - the answer to this question might seem easy. call the owner and tell her that her dog - in all likelihood - has cancer, right?

wrong.

i'm an emergency doctor. i don't have an established relationship with this owner. further, she doesn't like me, and she was upset that i incorrectly diagnosed her dog. she was seen by her veterinarian for follow-up care after my diagnosis. that vet - with whom she does have an established relationship - diagnosed something different and is treating accordingly.

so there's the difficulty of navigating the emergency doctor/referring vet relationship to consider. and here's the other part of the dilemma: lymphoma can be a tricky diagnosis on cytology. usually it's very straightforward. unfortunately, there are occasions where lymphoid hyperplasia (hyperactive lymph node) occurs and can mimic lymphoma. i've know cytologists to say that the two can be mistaken for one another. it's possible the cytologist is wrong. possible but likely? biopsy is the gold standard diagnosis - which is what the referring vet offered to the owners. they declined.

the dog is doing well on antibiotics appropriate to the disease the referring vet diagnosed (doxycycline for suspected tick-borne disease) and prednisone (which will TREAT AND SHRINK lymphoma, if present).

i've done my part. the owner is not going to like me, regardless of what happens. the results have been sent to the regular vet and now she can decide what to do from here on out, right? i should be out of the picture. the ball is in the rDVM's court as to how to proceed. and yet, it niggles at me. the owner of said dog was rude to me on the phone, had no faith in my abilities (this was even apparent the night i saw the dog as a patient), and it irks me - ESPECIALLY when i see that the cytologist agrees with my assessment of the cytology.

it is no matter. if it is lymphoma, and the dog is only treated with steroids - it has about 1-3 months of life left - at the very most. so i'll have the real answer, one way or another eventually.

i need to learn to swallow that desire to be right about everything, to have people know i'm right and know i'm a good doctor, learn what i can from the situation (which was still a valuable lesson, despite the fact that i turned out to be right), and MOVE ON.

ok.

moving on now.

any minute the moving on will begin.

seriously.

i'm just worried that in all this tiptoeing around the referring vets and irate owners, the animal's well-being will suffer. and that is strictly against the creed of "first, do no harm." i'm doing harm if my patient's illness is not managed accordingly.

dammit.

i lost a follower...

i hope it wasn't my story about the indecent man in new york city that sent follower #6 packing. if it was, i'm sorry to have offended. please come back and follow me again:)

bleh.

first day back...not fun. i had a really hard time getting my head straight this morning. i was foggy and kind of just...out of it. that - coupled with the fact that i'd been away from veterinary medicine for a whole week - was a bad combination.

i also found out that i likely mis-diagnosed a patient last week. i saw a 3 year old boxer with gigantic (and i'm talking lemon-sized) lymph nodes. my suspicion (given breed and history) was lymphoma. i did an aspirate (sucked cells out of the lymph nodes and made a slide) and thought it was lymphoma. i discussed sending out the slide to a cytologist for review - explaining to the owners more than once that i am NOT a cytologist and would prefer that one review the slides. they declined, because i did tell them that i was ... eh ... 90% certain of my diagnosis. we discussed further diagnostics, as well - including bloodwork and xrays. the owners declined that and took the dog home to talk about what to do.

that was the saturday before last. i called today to check on the dog because there were no notes in the computer that they scheduled for a follow-up visit. it turns out that the referring vet diagnosed the dog with tick-borne disease after conducting actual bloodwork. after treatment with appropriate antibiotics and steroids (due to the low platelets found on the bloodwork), the lymph nodes are normal in size, and the dog is back to his old self.

i feel rotten. yes, the dog is doing fine - and my mis-diagnosis was caught and no harm done. the owners were actually considering euthanizing this dog though, because he was so sick! they called their vet, and the vet recommended at least doing bloodwork and trying antibiotics.

i'm upset with myself because 1) i saw that my patient was a boxer with enlarged lymph nodes and immediately thought lymphoma (boxers are one of the most predisposed breeds) and 2) the owners might have euthanized him without doing further diagnostics based on my mis-diagnosis.

now, here's the catch. it could still be lymphoma. there's a free animal diagnostics lab in our state, so i sent the slides to them for reading, just to be sure. after spending 20 minutes talking to the (very, very nice) referring vet though, i think she was spot-on with her diagnosis.

and so i feel rotten.

on the bright side, the c-section i did on my last night before leaving for new york is doing well. the puppies are not, 2 were dead in utero and had been for a while, and the 2 live puppies were not fully developed. mama is doing fine though, despite a bloody and frightening surgery.

bleh. not a good first day back. maybe tomorrow will be better.

where does the time go?

home again. it's grey and warm here in the south. nothing like the bitterly cold but bright blue day i spent in new york yesterday. it was in the low 20s. luckily, the breeze stayed rather minor. i don't think i could have stood 24 degrees and a stiff breeze from the hudson.

my last day and a half were divine. friday night, we met up with a good friend from vet school and had dinner at a spectacular, small, cozy, and "inexpensive" (for new york) italian restaurant in the village called piadina. the food was absolutely exquisite. we began with corn polenta smothered in melted gorgonzola. i had a salad of bitter greens covered in thinly sliced pears, parmesan cheese, and almonds with a light sweet balsamic dressing. the main course was luscious. garganelli pasta in a light cream sauce of green peas and ham. dessert was the italian restaurant standby of tiramisu and espresso. for 3 of us to eat with an appetizer, 2 salads, 2 entrees, dessert, and espresso - it was $65. that's dirt cheap, by new york standards, and the food was absolutely amazing. afterwards, we visited the slaughtered lamb pub in on the corner of spring and ... some other street, and i had too many beers. we made it home around 2am. i also had a near miss on the subway. there are no public restrooms in new york city. a dangerous combination with my hamster bladder, consumption of too many beers, and being 30 some odd blocks from a bathroom i could use.

yesterday, myself and my friend roamed soho and the street markets for christmas gifts. we wound up in brooklyn momentarily, by accident (took the train the wrong way). it was a rather serendipitous accident, because the train came out on the manhattan (i think) bridge right around sunset. i got to see the brooklyn bridge and the statue of liberty and the manhattan skyline. it was a lovely sight, and a much needed rest for my feet.

we spent the whole day out and finished off by eating at the moonstruck diner - one of the many fantastic diners to be found in new york city. the food was great, as usual - but i still blanched at the $40 pricetag attached to a meal for 2 in a diner, of all places. gotta love the cost of living in NYC. we both collapsed early (9pm!!) because my flight was out of newark at 9:05, meaning my cab was coming at 6:30.

newark is about what i imagined - as is new jersey. flat, marshy, smoggy, ugly. of course, i only saw a tiny bit of NJ on my way to the airport, but it was kind of what i imagined / saw on the sopranos. my flight was excellent, surprisingly. i flew continental - which had muffins and juice and free blankets. my entire row (3 seats) was also empty on the newer jet - and so i had all the room i could want. my palms only sweated lightly on take-off, and otherwise, i felt fine.

so now i'm home and back to responsibility - starting with my animals needing various amounts of care (litterboxes, etc). tomorrow, i go back to work. i'm on days through sunday, so the 8am-6:30pm shift.

i'll be around with interesting cases to post, i'm sure.

the sun is out!!

i'll tell you what - new york city is depressing when it rains. since wednesday morning, it has steadily either drizzled or outright poured. coupled with the drop in temperature (30s), walking around can be exhausting. you've got to have gloves, a hat, a jacket, an umbrella, a purse...it's a lot of stuff to lug around and manage anytime you enter or exit a place. it was tiring! thank god the sun is out today and is supposed to remain out tomorrow for my last day here.

yesterday, i made my first foray into the subway alone. i only got on the train going the wrong way once, thankfully. otherwise, it was uneventful. i made it to soho and noho (i didn't know that existed, honestly), did some light window shopping (i haven't actually purchased anything in NYC, other than food), and got myself a huge slice of greasy new york pizza.

last night, my best friend and i elected to stay in, as the weather was bitingly cold and the rain continued to pour down. she made me dinner, we started watching tristan and isolde (a big fat thumbs down on that movie), and eventually fell asleep.

alas, the sun is shining today, and i am going to the village to do some christmas shopping for the people on my list. it's the first time since i've been alone during the day that it's not pouring, so i don't think it'll be nearly as depressing. new york city is a downright unhappy, sullen town in the rain. it's also kind of a lonely place to be without accompaniment during the daytime.

tonight, my other closest friend from vet school comes in from new jersey, and we're going out on the town. tomorrow, my friend is off work, and we're going to do the tourist-y stuff - the brooklyn bridge, coney island, hit up H&M, the empire state building, and whatnot. then i head back on sunday morning out of newark.

i love NYC, but i love home better.

how to pass for a new yorker

in my brief visit (and gleaned from my previous week here 3 years ago), i have figured out how to pass for a new yorker. here is my incomplete list (i'll add as things occur to me):

1) don't wear bright colors. black, dark brown, navy, and an angry expression are the standards for wardrobe.

2) don't smile. it automatically gives you away as a non-new yorker. strive for a look somewhere between sullen indifference and sneering cynicism. a cigarette really helps. if you don't smoke, talk angrily into your cell phone. and loudly.

3) while waiting for the walk signal at each block, DO NOT stand on the actual sidewalk. those who are not from new york stand on the sidewalk. stand about 6 inches from the sidewalk, actually in the road else you'll just look like a noob in the big city. if cars and cabs are blocking the intersection and you have the white walk signal, weave through the cars to cross. if someone inches forward as you walk in front of them, gesture angrily OR cut them down with a freezing glare. alternately, if you're feeling bold - hit the hood of the car with the palm of your hand and use an expletive such as a$@hole.

4) do not make eye contact while walking on the street. EVER. PERIOD. there is no getting around this rule.

5) this is an addendm to rule #3: while hailing a cab : stand IN the road, raise one hand, and look really impatient. when a cab with its light on drives right past you, throw your hands up in the air to exhibit your utter exasperation with the whole of new york city cab drivers.

6) walk very fast. if you see someone coming toward you, do not - under any circumstances - deviate from your path. if this involves playing chicken with the oncoming traffic, then by god - play chicken. you're not moving out of anyone's way.

7) if a cell phone is lacking, have headphones on. this way, you won't ever be mistaken for showing ANY interest in the seething mass of humanity around you.

new york is composed of the loneliest mass of humanity i have ever seen. more to come later after my dinner in chinatown and my shopping excursion for christmas gifts.

day 1 recap: chicago, giant rodents, masturbating man

yesterday was a whirlwind of activity. my plane landed (on time! and uneventfully) aorund 1:15. i took a cab to manhattan (east 53rd) and met my friend. it was as if no time at all had passed. it seems to always be that way with good friends. i was starving, because i hadn't eaten for nearly 24 hours. we picked a good little mexican diner near her house called blockheads. the food was excellent, as seems to be the case everywhere you go in NYC. i guess because the competition is so fierce? at any rate, we filled up on delicious mexican food then went to visit the famous AMC (animal medical center) where she is doing her internship.

it amazed me that after a mere oh...8 hours away from home and work, i was already yearning for the presence of a few fluffies. we visited the exotics ward, so i could get a brief birdie fix. aftewards, we roamed the city like bandits. we visited madison ave, 5th avenue, rockefeller center (the tree is amazing), stopped in at gucci and betsey johnson and nine west, and generally drank in the city and all its pulsing life.

whilst in rockefeller center, we met a handsome mounted police officer in his mid
20s who tried to pick us up. my best friend gave him her number, i demured and stood in the background, trying not to crack up. after all, shouldn't he be doing...oh, i don't know - cop stuff?? and my friend is always complaining about not being able to meet men. we met three on our stroll around the island! and we never left our side of the island!

afterwards, i told her "hey - at least you know he likes animals!" his beautiful quarter horse was impeccably kept and wonderfully fit.

we ate a very light dinner at a bar and grill (charley o's) in times square and then went to see chicago at the ambassador theater. it was not exactly what i expected. for one thing, the backdrop was the same the entire show. the actors wore the same costumes, with very mild changes (additional jewelry, different shoes), the whole show. i guess i expected crazy, flashy, incredible sets and costumes...because it is broadway, after all. it was a good play. it wasn't fabulous. i wasn't completely blown away, but i thoroughly enjoyed myself. i had a long island ice tea (which has NO tea in it) at charley o's. that, combined with my small size, general lack of drinking habits (i haven't drunk anything alcoholic in weeks), and my exhaustion at traveling and just coming off overnights, pretty much made me slightly more tipsy than i expected. it made the whole experience that much more enjoyable.

afterwards, we strolled the leisurely 11 blocks or so back to home. on the way, i wanted to stop and take a picture of radio city music hall. as i was standing in the square across the way, trying to get the light right, i felt something aggressively brush/grab my lower leg. i thought a person had grabbed me. i glanced down and to my HORROR saw a large rodent dashing for the nearby landscaping arrangement. i kid you not. a drunk (he must have been, to run into me like that) NYC rodent tried to maul me.

it only got better. as we stood on the corner of park avenue waiting to cross, a man in a dodge neon crept by us very, very slowly. i thought he must have thought we were prostitutes or something, despite our conservative garb. that was until i noticed that he was masturbating with the window down as he cruised by.

ahhhh...welcome to new york city!

in all seriousness, it's 8am, and i can't get back to sleep. the city awaits. my friend is working, but i have all day to roam around and see the place. amazingly, it's in the high 50s here, so i'm not going to have to wear 37 layers and be miserably cold. i can actually wear a light jacket and be comfortable.

i promise that there will be more to come as i commence my next 4 days in the big city.

17 hour countdown....

in 17 hours, i will do the thing that i enjoy least in the world. i will board a plane and fly.

but when i touch down (as opposed to crash and burn, i hope)...i will be in the land of the manhattanites. my favorite city in the world (thus far) - though i haven't been to paris or rome or madrid yet - will once again welcome me with open arms. this time i go sans husband, which will be a rather new experience.

my best friend got tickets to see chicago tomorrow night on broadway. yes peeps - a little later then this time tomorrow evening, i will be watching a broadway play. i'm sure you can imagine my excitement.

on friday night, i will also get to see my other closest friend from vet school. she's doing her internship across the bay in new jersey. she's coming into the city for dinner and hanging out on the town.

it's going to be so great to get away from this state for a while, to get away from pets and responsibility, litterboxes, bird cages, vacuuming, my job and thoughts of my job. i'll be away in the land of tiffany's and rockefeller center and the empire state building.

i'm sooooooo excited...so much that i'm almost not fretting about flying. almost.

FAIL

i know i said that i would try to post upbeat cases. for the life of me, i can't think of any that are interesting. i know that can't be the case, but it's the ones that you lose that tend to stick in your mind.

last night was a loser night. i saw a lovely chocolate lab / pit mix. he had been taken in by a good samaritan, as he was free-roaming and unloved. as i was listening to his heart, he nuzzled up between my cheek and shoulder and proceeded to lick my neck and head butt me (like a cat). his new owner of 1 month was a young girl (early 20s) excited for her upcoming marriage. as soon as i looked at the dog, my heart sank. he presented for staggering and swaying, as well as running into walls. he was also vomiting frequently. a free roaming dog with those signs means only one thing. start the antifreeze testing.

he was indeed, poisoned. antifreeze is a terrible thing. unless caught in the first 8 hours, treatment is pointless. even sometimes before 8 hours, they don't recover. 9 times out of 10, the animal will die. this guy was already showing elevations in his kidney values. the owner had no idea when he was exposed. treatment for a dog his size would have been very expensive - and perhaps fruitless. we euthanized him, needless to say.

on his heels followed a 13 year old blocked cat. fairly routine in emergency medicine. except that this guy had a quiet, very focal (1/6) heart murmur that i missed on my physical exam. when he received his fluid bolus prior to unblocking, he developed pulmonary edema secondary to his undiagnosed heart disease, started vomiting (a symptom of fluid overload), and collapsed. he recovered from that after 2 hours of oxygen, but the stone in his urethra could not be moved. neither myself, nor my senior clinician, nor the internal medicine specialist could budge the stone. despite repeated cysto (sticking a needle in the bladder to remove the urine), his potassium continued to climb (this leads to slowing of the heart and death, eventually). i talked to the owners about surgery, but his prognosis was guarded with his heart disease. they elected to euthanize the sweet little guy. his owner was a mother and her teenage daughter, both in tears and extremely grateful to me for my (i thought rather poor) care.

the icing on the cake? this morning before leaving, i ran into the students that come up from my alma mater every 2nd and 4th friday to do spays and neuters. one of them was a guy who ... honest to god, as evil as this sounds ... if he died, i'd probably throw a party. he did a terrible thing to me in vet school, and i've never quite gotten over it. of course, he would be there.

ok. i'm going to curl up in my warm bed with my husband and warm kitties and try to forget last night and its accompanying failures. for every animal i euthanize, there is are at least 2 to 4 that i send home with their owners for many more years of life.

tonight is another day.

oh....my....i might....faint

i have information that i cannot post on my blog about my favorite band in the world - the avett brothers. it's secret information about a possible show somewhere where i would be able to meet them, hang out with them, and sit in the front row.

i think...i might...faint.

mumblings, an impromptu trip, my itinerary

last night was my first night back on overnight emergency. we saw ONLY cats. eight of them, i think. it was a typical slow monday night during our (yes, it's apparently real) recession. i enjoyed it, because i am a fan of the kitties. not a single dog came our way. it was odd...something to do with the cold, snowy-ish weather? i don't know, just a theory.

so the holidays are always a little depressing. i'm not sure why. i'm lucky enough to have great family and friends with whom to spend it, and despite the fact that i'm working on christmas this year, i do have the 3 days off beforehand to spend with friends and family. my schedule this month is awful. i'm working 20 days of 31 - and 7 of those off days are next week! in a real job with 40 hour weeks, that would be fine. in my life, with 90-100 hour weeks...not so fine. the thought of my 5 days on starting christmas and extending through the weekend is giving me nightmares (it's going to be very, very bad- especially if thanksgiving was any indicator). ah well. i'll survive.

the point of that was that i talked to my close friend who is doing her internship in manhattan. she is lonely, recently broke up with her boyfriend, works 6-7 days a week, and is very, very depressed. she called me in tears last night while i was at work.

so...i'm a bit depressed too. holiday blues, i suppose. i have the whole next week off, and tickets to NYC are $234 round trip from atlanta (+37 for the shuttle to atlanta). so guess what? i'm going to NYC next week for a spur of the moment trip - leaving early tuesday morning and returning sunday. i'm so excited i can barely stand it! i'll get to see one of the people i love most in the world, in a city i love, for 5 days. i love NYC in the winter, even though it's cold. i find rockefeller center and the tree and all the displays in the windows to be romantic. it would be nice to someday go to NYC in the spring...but...perhaps another time.

i'm thrilled thrilled thrilled thrilled thrilled!!!

i'm also flying to orlando in january to attend the annual north atlantic veterinary conference (NAVC). i'm renting a car and staying with my grandparents for the week (it's a long commute...but i figure it's worth the family time - and my CE funds pay for everything). so i'll be gone for a week in mid/late january too. then in february, i go to north carolina state for a rotation in cardiology. i'll be driving to NC State.

i'm gallivanting all over the place, eh? it'll keep me occupied and lively, which is good. sometimes i think i'm getting into a rut.