I love having a kitchen that begs me to cook. If I don't get in there at least once a day, I hear a little voice calling me..."cooooooome, use my oven. Turn on my buuuuuurnerrrrs. Microwave soooooooooomething..."
New recipe tonight: green pepper soup. I know - it sounds kinda yucky. The recipe was given to me by a technician at work. Since I do love peppers, I decided to give it a whirl. What a surprise! It's a very mild, light, sweet soup that would be a perfect starter course for a big meal (steak, roast, etc). We had it with a salad and crusty french bread.
The recipe is super easy, but it does call for a blender. I didn't actually own a blender until today. We went to a cooking store in the mall (not Williams Sonoma. Surprisingly our local, enormous, tourist attraction mall lacks a WS). I could have spent HOURS and HOURS in that store looking at all the cooking equipment. It was rather like a porn store for cooks.
The recipe is as follows:
1 tbsp butter 1 tbsp vegetable oil 4 large green peppers, chopped 2 large onions, chopped 1 tbsp flour 4 cups chicken broth 1 cup 1/2 and 1/2 1 tsp salt 1 tsp pepper
Sautee the peppers and onion in the butter and oil until tender in Dutch oven or soup pot (about 5-7 minutes on medium heat). Add the flour and mix until smooth. Once smooth, cook on medium high for 1 minute. Gradually stir in the chicken broth and mix well. Bring to a boil, then turn down heat and simmer for 5 minutes. Divide the soup into half and puree each half in a blender (or food processor) until smooth. Place back in soup pot (or Dutch oven). Add 1/2 and 1/2, salt, and pepper, stir over medium heat. Serve garnished with green onions.
My first cheesecake is in the oven as we speak. I'm a bit nervous, but we shall see.
On the hobby front: I've signed up for Level 1 Spanish class to commence in January. It's an "immersion" style class in which you are taught conversational Spanish. It's taught at a local language academy and the goal is teaching you to comfortably converse in Spanish. It's something I've been wanting to do for a while, but vet school and my internship made having hobbies difficult (to say the least)!
My father was a Spanish translator when he was in the Army and was a fluid Spanish speaker. He picks up languages easily, and I have inherited this trait from him, luckily. This will serve me well in life, I feel. We deal with a great deal of Hispanic people at work, and it would be enormously helpful to be able to converse with them on some level. Further, I just like languages and hope to be able to use it one day when we FINALLY travel.
Tomorrow, we leave for Knoxville to visit friends, then Saturday we drive to Nashville to see the Avett Brothers at the Ryman with other friends. I'm very excited!
Most days, this is true. However, by the time 6:00 o'clock rolled around today, I was a potato. Stick a fork in me, I was done.
The morning got off to a rollicking start with a 15 year old cat exhibiting very odd neurological signs. She had a history of severe urinary tract infection one year previously but nothing since then. She was the picture of health until that morning, at which time she became acutely unbalanced and stagger-y. When I examined her, she had blood clots around her vulva. Ultrasound of her bladder showed an incredibly thickened bladder consistent with chronic inflammation. She also had a terrible yeast infection in both her ears. I was confused. Was she showing vestibular signs (dizziness mainly) due to her inner ears? Did she have a terrible painful UTI? Was the bladder a red herring - a problem that had been around for a long time? Did it have anything to do with the neurological signs? In other words, WTF? In the end, I treated the cat with an anti-nausea/motion sickness medication for possible vertigo/vestibular disease and a pain medication, with a recommendation to see the regular veterinarian in the morning for further testing.
My next case was no better. A 120lb German shepherd acutely down in the rear limbs and in excruciating pain. He snapped at the owner while being brought into the clinic. I examined him, but it was extremely difficult, since he could not stand. It took 4 of us restraining him to get anything done. As we were lifting him to see if he could walk, my tech slipped off his muzzle so he'd stop fighting with us. Quick as a snake, he whipped his head around and bit her hand. I HEARD the crunch and almost vomited. Blood began pouring out of her hand. She held it together for about 30 seconds before the sobbing began. That patient went to see kitty Jesus shortly thereafter (because of his illness, not because of the biting).
After my tech was shipped off to the ER, the next case came rolling in: a 5 year old pregnant Doberman. She'd had "spinal trauma" more than 6 months previously. That was what the small swelling on her hip was diagnosed as then. Now, the "small swelling" was a mass that was 10 inches in diameter, so large that it was pushing her rectum and pelvic canal shut. She couldn't urinate or defecate, and she was in excruciating pain. Her bladder took up her WHOLE abdomen. Once I emptied it, I could see the puppies. On xrays, the mass was already eating away at her pelvis and femur. There wasn't much I (or anyone) could do at the point. She too went to see kitty Jesus.
Then came the puppy with the soft, fluid filled swelling taking up his whole head. A true WTF? moment if there ever was one. Of course, the owners had no money to treat or diagnose...
Today was a reminder that sometimes I hate medicine. Sometimes I hate my job. Sometimes I really really wish that I did something that didn't matter to anyone. That I could go home at the end of the day and not even think about my work day for one moment.
After all, does it really matter if I overcook someone's filet mignon? No. Does it really matter if I accidentally kill someone's beloved pet or make a mistake in my drug calculations? And how many times do I actually help animals anyway? How many times would they get over it on their own or die on their own regardless of what I did or didn't do?
On Friday afternoon, a referring veterinarian called to let me know she was sending over a dog that would require oxygen therapy for the weekend. "Choco" was a 12 year old labrador mix with previously diagnosed megaesophagus, aspiration pneumonia, and possible myasthenia gravis. On top of that, he had recently been diagnosed with likely laryngeal paralysis. His owners were an elderly woman and her daughter. The mother took care of the dog while the daughter worked during the day.
The referring veterinarian confided to me that the owners just weren't ready to let the dog go, even though with the combination of a dilated esophagus and previous aspiration pneumonia, he was a very poor candidate for surgery to repair his laryngeal paralysis. Basically, Choco was going to spend the last few months of his life starving for oxygen at all times.
When the owners came in, they had many questions. We discussed Choco's condition, and I ended up spending a great deal of time with them, despite having numerous patients to care for.
I explained to them that when breathing room air, Choco's hemoglobin was only saturated with about 75% oxygen, meaning he was chronically hypoxic (oxygen-deprived). With nasal oxygen, this improved to almost 100%. Unfortunately, he couldn't live with nasal oxygen (as people can). We discussed that his problems weren't going to get any better, not unless surgery was attempted to help with his laryngeal disease.
They understood all this, cried when they left him in my care, but didn't make the decision to euthanize.
Through the night, I watched him struggle. Sometimes, he had to stand so that he could breathe. His harsh breathing reverberated throughout the clinic. My techs asked me again and again, couldn't I give him something? My answer was always the same : save sedation, not much could help him short of intubation and surgery. Finally, at 3am, I called the owners and asked them what they wanted to do. The daughter had many more questions, but the answer was always the same: prognosis very guarded to poor.
She told me that she would call back.
Three hours later, the front doorbell rang, and there they were. More questions followed, then tears. I gave them time to think about the options, as I checked on Choco - still laboring to breathe, despite intra-nasal oxygen and sedation.
When I went back out front, they told me - with tears in their eyes - that it was time to let him go. I felt a flood of relief for the poor old guy, but also sadness for his 2 obviously distraught owners.
As I sat and talked with them about the process, the older of the 2 confided in me that Choco had been a "good friend" and it was important that he didn't suffer.
In the end, he went quietly. The owners sat with him on the floor, crying quietly, and talked to him after he was gone.
It was painful to watch, even more painful to be a part of, but in the end, it was a relief to end his suffering and to let him go peacefully, surrounded by the people who loved him most in the world.
I traffic in bad smells. It's just part of the trade: male cat urine, dog poop, anal glands, impacted anal glands, abscesses, wounds, maggots...you get the idea.
So, is it any wonder then that a naughty dog who has JUST ingested a freshly bake chocolate cake is my absolute favorite emergency to see?
I saw a 100 pound black lab/great dane mix on Saturday night. He practically inhaled a fresh, 9 inch harvest chocolate cake off the counter after his owner finished baking it. She brought him right to us, a mere 10 minutes after said crime.
A large shot of apomorphine later, and practically an intact chocolate cake was lying at my feet. For the amusement of the techs, I took a plastic knife and cut into the cake, exposing the moist, fresh, almost perfectly whole inside of the cake. I could have cut a slice, put it on a plate, and no one would have been the wiser. There was still steam coming from the inside.
The whole clinic smelled of pleasant, recently baked cake. So much so that the midnight technician commented upon walking in the door, "hey, did someone bring cake?!"
(My husband implored me to post this little anecdote (if you will) on my blog...so, since he's such a RARE reader of my blog, I thought I'd oblige)
I had my 2nd GDV in 4 days last night. It seems to happen every time I'm on my last night on before the break (Sunday) - some big surgery. The last time, it was my nasty but fun GI intussusception. The owners of that little dog brought her by to visit me on Friday night along with a thank you card. She is doing great.
My other GDV is recovering and eating well. Last night's GDV went well and recovered great...so here's hoping!
Any similarity between my stories and any person or animal, living or dead, is strictly a coincidence. Names, breeds, sexes, and details of the stories have been changed to protect the guilty and innocent alike.
I am an emergency veterinarian in North Carolina. Despite the crazy people I deal with, the awful cases of injured and sick animals, and the overall stress of emergency work, I absolutely love what I do. Happily married since I was 20, I have a wonderful husband who has a PhD in Mathematics, and a daughter around whom our world currently revolves. We also have a zoo living in our house that can be alternately wonderful and maddening. There are cats, parrots, and a dog who is very low on the totem pole. Our days are never dull and we are learning to balance the demands of work and family.
If you'd like to contact me: firstname.lastname@example.org
Azotemia - elevation in kidney enzymes (BUN and creatinine) indicating dehydration, kidney failure, or urinary obstruction
Lactate - a salt/ester of lactic acid that is produced as energy for a cell when oxygen levels are low. In critically ill animals, elevated lactate can be an indicator of inadequate blood flow to organs (perfusion), decreased delivery of oxygen, and/or decreased oxygen uptake. Values > 6-7 are usually considered to be poor prognostic indicators for survival.
GI sloughing: when the cells lining the GI tract die (can be secondary to MANY things, including heatstroke) with resulting bloody diarrhea, bacterial translocation into the bloodstream and sepsis
TTJ: transfer to jesus: code for when an animal needs to be euthanized or die
DIC: disseminated intravascular coagulation: a very, very bad thing - when the hemostatic system gets out of whack, and clots start forming in the blood vessels until all clotting factors are wasted. once those are gone, internal hemorrhage ensues, followed by death, usually. also known as "death is coming"
Pleural effusion - fluid contained in the pleural space (chest) - this is not the same as fluid in the lungs (see pulm edema) - in cats can be caused by infection in the chest, heart failure, cancer, FIP, feline leukemia, FIV, and in some cases, the cause is never found (idiopathic)
Anisocoria - unequal pupil size (related to any number of causes including brain damage/head trauma)
Laterally recumbent - lying on side, unable to rise
Hyperglycemia - elevated blood glucose
Hyperkalemia: elevated blood potassium - a life-threatening condition related to several disorders (kidney failure, antifreeze toxicity, urethral obstruction...etc)
Sepsis - refers to a bacterial infection in the bloodstream or body tissues. This is a very broad term covering the presence of many types of microscopic disease-causing organisms.
Nephrectomy - kidney removal
Splenectomy - removal of spleen
Pulmonary edema - condition in which fluid accumulates in the lungs, usually because the heart's left ventricle does not pump adequately ( can be caused by heart failure, electrocution, drowning, too many IV fluids, to name a few)
Tick borne diseases - any of a myriad of diseases transmitted by ticks - including but not limited to Rocky Mtn Spotted fever, Lyme disease, Ehrlichia
Fine needle aspirate - A method of sampling in which a needle is used to suck in cells or tissue bits for diagnoses (good for diagnosing masses/lumps)
Blood glucose - The principal sugar produced by the body from food–especially carbohydrates, but also from proteins and fats; glucose is the body's major source of energy, is transported to cells via the circulation and used by cells in the presence of insulin (normal range in a dog/cat is 75-100)
PCV - packed cell volume - the volume of packed red cells in milliliters per 100 ml of blood (normal range 35-45)
Diseases I see/treat frequently
Dystocia - difficulty birthing. May be responsive to oxytocin administration (Pitocin, as in people) but may require c-section.
DKA - diabetic ketoacidosis: the extreme end of the diabetic scale. A patient that is diabetic can develop DKA when other diseases make the blood glucose hard to regulate. Other diseases that are commonly associated include urinary tract infection, pancreatitis, pyometra, skin infection, and cancer. In DKA, the body starts metabolizing fat and producing acids that cause a drop in blood pH, nausea, weakness, severe dehydration, electrolyte derangments, and death.
DCM - dilated cardiomyopathy: an idiopathic (cause unknown) cardiac disease in which the heart chambers become very thin/dilated, and cardiac output drops radically. Causes arrhythmias, tachycardia, and sudden death. Seen in large breed dogs like Dobermans, Great Danes, etc.
Lymphoma - cancer of the white blood cells, the most common and treatable form of cancer in dogs
Blocked cat - slang term for a male cat with a plug of mucus and crystals obstructing the urethra (fairly common in male cats) definitely a life-threatening because urine can't get out of the body! If present long enough, causes shock, acute renal failure, hyperkalemia (elevated potassium), coma, and death. Symptoms include straining in the litterbox, yowling while trying to urinate, producing small, bloody drops of urine (also symptoms of feline cystitis, a non-lethal condition)
GDV - stands for gastric-dilatation and volvulus - a condition of large breed, deep-chested dogs (usually) in which the stomach rotates 180 degrees on its axis and thus - nothing can enter or leave, considered the "mother of all emergencies" - it warrants immediate surgery and carries a guarded prognosis
IMHA - immune-mediated hemolytic anemia. A disease in which the immune system attacks the red blood cells and destroys them. It causes profound anemia and is life-threatening. Causes are primary (no known cause) and secondary ( tick borne disease, cancer, and heavy metal intoxication). Treatment is immunosuppression with drugs primarily. Prognosis is guarded at best.