Saturday, October 29, 2011

The curse of being a veterinarian

It's kind of a joke in my field (and probably every field has their variation of this) - but veterinarians ALWAYS get the animals with the rare diseases, the congenital abnormalities, or the undiagnosable illnesses. Apparently, this extends to family members, as well.

A day or 2 after Evaline was born, my aunt called me about her 10+ year old Labrador/Great Dane mix. He was severely lethargic to the point where he would not rise. His breathing was labored, his gums were pale, he had severe bruising on his abdomen, and his extremities were cold. My aunt also noticed that his abdomen looked distended.

Any other Labrador with these symptoms would have a ruptured splenic or liver mass. It's as common as grass! I see at least 3 rupture splenic or liver tumors a month at work, and they are almost all Labradors or Golden retrievers. I recommended she get him to her veterinarian ASAP.

Dr W did a thorough exam on Flip and could not find evidence of a splenic or other abdominal mass. Flip's clotting times were abnormal, though. Given that Flip is an outdoor dog and because of the way the clotting times were elevated, the vet suspected rat poison and started treating accordingly. Initially, Flip responded and seemed to do well.

Then he started to deteriorate again and became severely, severely anemic. The veterinarian ordered packed red blood cells to give him a transfusion. When he rechecked the anemia a couple of days later, it had resolved! Flip seemed to be improving. He was discharged home, and he became lethargic again.

Further, he was now having trouble walking - as his back end was weak. He was almost walking on his elbow in one rear leg. The muscles were wasting away (atrophied), and he had developed a fever.

Last weekend, my aunt brought him to me to ultrasound his abdomen, looking for a culprit. I found nothing to explain his symptoms. He was still feverish. With no answers, I started him back on doxycycline (an antibiotic used to treat tick-borne disease such as Rocky Mountain spotted fever, Lyme, and Ehrlichia) and prednisone (a steroid).

His condition has not improved, and his atrophy has worsened in the rear limbs. I am going to euthanize him tomorrow at my aunt's house.

And still, I have no answers. I highly suspect some sort of cancer, but this could be tick-borne disease, autoimmune disease, or anything else. I am highly frustrated! I am a good veterinarian, and usually I at least have a handle on what is causing a patient's illness. In this case, I am left baffled.

Unfortunately, the veterinarian's curse strikes again - making me feel rather like a failure.

Tuesday, October 25, 2011

Still here and an unexpected shift at work

It's amazing how quickly large chunks of time pass without me realizing it. It must be due to the confusion my body suffers due to my wacky sleep "schedule" (which is no schedule at all). I could swear I just posted about cats and permethrins - but it has been over a week!

At any rate, guess what I did this weekend? I worked a short shift. My colleague qualified for a large regional dressage competition. She couldn't find any relief vets to work her 8am-1pm Saturday shift, despite trying for several weeks. She asked me to do it. Once I got over my initial irritation at being bothered while I am enjoying my maternity leave, I realized that I kinda wanted to do it.

Motherhood is wonderful, and I love, love, love spending time with my daughter. On the other hand, my husband is frantically working on his thesis (his defense is looming in the next few weeks), leaving me to try and manage the baby by myself. He is wonderful and steps in to help any time he thinks I need it, but I'm trying desperately not to bother him. Also, since I am exclusively breastfeeding, I am with the baby most of the day. She also sleeps with me, so I have very little time away for myself. This is the plight of all new mothers, and it's a big adjustment. My husband and I have been married for 12 years, always able to do as we please, when we please. It's been a pretty fancy free lifestyle, honestly. Having a little person to care for 24/7 is a huge change. It's like this for everybody, I realize - so nothing new there. You just don't realize HOW MUCH your life revolves around a baby until you have one. No matter what people tell you - there is no way to prepare.

At any rate, the thought of being with other adults and back at work for a few hours was really enticing, so I accepted her request. I also want to build good will at work. It was a Saturday morning, so it was slow. I saw a dog with a badly broken leg and a cat with a terribly degloved tail, and otherwise, I sat around and caught up with my technicians. Still, it was refreshing to be back at work, even for a short, boring shift.

I wonder if I could be a stay at home mom. Just a few short weeks ago, that thought was enormously appealing. Now that I've been away from work since the end of September, I realize that I really do love what I do and want to continue doing it. I also want to be an involved parent. Life to me seems to short to waste on working, no matter how much I love what I do. It's a conundrum.

Is it possible to be a great mom and still work a demanding job? I guess we'll find out. On the bright side, my job allows me large blocks of time off, which I can spend with my family.

Sunday, October 16, 2011

Cats and permethrins

I can't recall if I've ever talked about this before, but I thought about it when I was doing the 5 things post. #6 would be: if a product is labeled "not for use in fill-in-the-blank species" then DON'T USE IT IN THAT SPECIES.

If you go to Wal-Mart, K-Mart, Target, and the like, you can find over-the-counter flea and tick medications for your pet. These run the gamut from what were once veterinary-only products (Frontline/fipronil, Advantage/imidacloprid, etc) to OTC products that have always been such. If you look closely at certain major brands you will see that several are prominently labeled "DO NOT USE IN CATS."

That is because these products contain pyrethrins/permethrins - chemical compounds that can lead to seizures and death in cats. For some reason however, people tend to ignore these bold warnings and use these products on cats anyway. Some cats will never have any problems, for reasons that are not clear. Other cats will have a mild, tremoring reaction. Still other cats will seizure so hard that they will appear to be levitating.

These drugs kill fleas by screwing up the sodium and potassium channels in cells. These channels are responsible for mediating conduction of impulses along nerves. When these drugs interfere with Na/K, the targeted species (for example: fleas) basically twitch to death because of interruption of normal nerve conduction. The same happens with cats when given these medications. Cat livers are not as efficient at metabolizing certain drugs (such as acetaminophen, the active ingredient in Tylenol and permethrins). As a result, clinical signs develop.

This toxicity can be treated. Unfortunately, most cats (except for the most mildly affected) will require 24-96 hours in the hospital with IV fluids, anti-seizure and muscle relaxant medications, possibly lipid therapy, and intensive care. In some cases, affected cats must be put under general anesthesia with either Propofol or inhalant anesthesia to stop the tremoring/seizuring. In some cases, it cannot be controlled at all.

It is not inexpensive to treat either - which is the saddest part. Most people put these medications on their cats to save money, not realizing that a hospital stay to treat this is going to cost in the neighborhood of $700-2000 depending on the severity (or lead to euthanasia in many cases due to financial constraints). If you break down the math ($60-90 for a 6 month supply of safe, veterinary proved product = $10-15/month) - prevention is the BEST and cheapest treatment.

Lipid therapy is a newer therapy that is very interesting to me. Permethrins are highly lipid soluble. This means that they move into the fat of the body very well. Synthetic lipid compounds are produced by pharmaceutical companies and used often for feeding patients intravenously. It has been found that if you infuse these compounds into patients with exposure to lipid soluble toxins, they form a "lipid sink" for drugs - meaning that instead of being internalized into the body's fat stores, the permethrins are bound up with the lipid we administer. As a result, they are not broken down in the body in such a way as to cause clinical signs. This is the theory anyway.

Lipids themselves are a cheap treatment option (about $20/bag - a small dog will only use about 10-20 millileters, and a bag holds about 500 milliliters). We have this in stock at our clinic, but I haven't had a permethrin case yet! I have used it on a ivermectin toxicity.

Moral of the story: the best treatment? Prevention!

Friday, October 14, 2011

Sorry for my AWOL status - new mommyhood and all. It's been wonderful and exhausting at the same time. Thankfully, my job has prepared me well for being the mother of a newborn. I don't have any trouble getting up and taking care of the baby in the middle of the night. I'm also dealing fairly well with sleep deprivation. Crazily enough, as much as I love being a mom, and as much as I never want to be away from my little butterbean, I actually miss work. We had a doctor's meeting the other day, and listening to my colleagues talk about cases made me crazy to be back in the ER. I'm not spending time dwelling on that, as these precious few weeks will fly by - and I will go back to work and miss my daughter desperately. Dec 7 is THE day...

Thursday, October 6, 2011

Top 5 things I wished pet owners knew (but don't)

This was a requested post, and I thought it was a good idea. I'm sure I will expand this list one day, but for now, I am sticking with 5.

1) Aspirin, ibuprofen, Tylenol, Advil, etc. are the not the cure-all for every problem a pet suffers. I cannot tell you how many pets I see with every symptom known to man (vomiting, diarrhea, lethargy, weakness, stumbling, loss of appetite) that have received an NSAID at home. These are painkillers that help with inflammation. They are NOT going to do anything for a vomiting dog. Just like YOU wouldn't take aspirin for nausea, neither should your dog. Further, these products are dosed differently (or not at all - in the case of naproxen in dogs and Tylenol in cats). These medications can pose serious threats to your dog's health.

2) Allergic reactions to beestings, pollen, and the like that cause facial swelling, itching, and hives/wheals are not life-threatening emergencies requiring immediate care. I shouldn't complain, as this is job security for me - but if your dog breaks out in hives, his face swells, and he starts to itch like mad, give him Benadryl, and wait it out. It can take up to 24 hours for the hives and swelling to completely resolve. This cutaneous reaction is not life-threatening in any way. Now, if your dog has trouble breathing, collapse, weakness, or the like - that IS an emergency.

3) A dog or cat is not embarrassed by the words "penis" or "vagina" or "vulva." Neither am I. You can use them freely. I do NOT like the words "lipstick", "hooha", "wee-wee", or "peanut."

4) I have no control over prices, billing services, or anything else to do with the financial aspect of the pratice. I am an associate, I do not own any part of the clinic, and thus, if I give you a discount or do things for free, then I am essentially stealing from my employers. Do I sometimes do things at a discont? Yes. Should I? Probably not. Oh, and I don't drive a Porsche. I drive a 13 year old Mercedes SUV that guzzles gas, has 210k miles on it, and was a freebie hand-me-down from my generous father-in-law.

5) Lastly, I wish that pet owners knew that I love my job, take it incredibly seriously, stay up nights worrying about cases I'm managing, strive to always, always do my best for every pet
I see, and constantly berate myself when I can't save the world.

That about sums it up for me, at the moment!

Tuesday, October 4, 2011

For lack of words :)

Sunday, October 2, 2011

The first 3 days - breastfeeding trials and tribulations

After labor, I felt fantastic. Despite being awake for about 24 hours, I felt like I could do a lap around the hospital. Eva was borderline hypoglycemic after birth, and she was having a bit of trouble with the latching/breastfeeding. I didn't want her to continue to become more hypoglycemic, and I wanted to avoid interventions like an IV catheter/dextrose, so I acquiesced to her going to the nursery for a bottle. My husband went with her. They moved me to a recovery room. After 20 minutes, I was so restless and worried about her that I trucked down to the nursery to check on her. Apparently that was a no-no for a recently delivered mommy. That's how good I felt though.

We opted for having her sleep in the room with us, as I couldn't stand the thought of her going to a nursery and being away from us. We plan on "attachment parenting." Basically, keeping her with us at all times. This includes co-sleeping (or "sleep sharing") which is controversial. I will say that the first night, she would not settle in her bassinet. I did not sleep the entire night. Doctors, nurses, dietitians, and everyone else came traipsing in and out from 8am-1pm. Then lunch, etc. So I didn't sleep again. The second night was agony. My nipples hurt from breastfeeding, I didn't feel like I was getting a good latch, she was frustrated, I was frustrated, and totally, utterly exhausted.

By the second morning, I had been up for 50+ hours. I was so tired that I was borderline hallucinating. I burst into tears when breastfeeding because it hurt so much, and we were both frustrated. She wouldn't sleep in the bassinet. So, I moved her into the bed with me, and we both finally, finally slept (around 6am). It was very restful. It solidified my position on co-sleeping with her.

When we were finally discharged on the 2nd day, after her PKU test, a tetanus/diphtheria/pertussis vaccine and an MMR for me (turns out I am not immune to rubella), and the other formalities, she began to cry right before we left. I knew she was hungry, but it was only a 30 minute drive home. Of course, we got stuck in crawling (but moving) traffic. She wailed and wailed like her heart was breaking. I was able to stand it for ... oh, about 5 minutes, then I burst into exhausted tears too.

Now, we're home. My mom is here and has been taking care of whatever we ask her to do. As a result, I have been able to sleep some, although I am still very tired. Breastfeeding is still a challenge - it hurts much more than I expected.

I will say that my job has prepared me well for the waking on command and being able to be coherent (at least, coherent enough to change a diaper and feed the bebe).

So, what have I learned in the first 3 days of motherhood? Sleep when you can (not good at this yet). Comfortable, easy clothes for nursing are a must. Having a stay at home dad to help makes being a new mommy 10,000 times easier on you. And finally - it is absolutely amazing how much you can love someone you have known for only 3 days. It is also absolutely terrifying.

Saturday, October 1, 2011

Baby posts?

So, I know you guys read my blog for the veterinary stories - as it IS a veterinary blog. In the last 3 days, I have already learned so much I didn't know about being a mommy. I want to chronicle this, all of it. For her and for me, so that next time we have a baby, I will be able to read and remember. I also want her to have it for the day long in the future (only relatively) when she has her first baby and has a thousand questions like I do. My mom, God love her, had 5 natural childbirths, but she says she can't remember stuff anymore about the labor/delivery/post-partum period. Hopefully, if I record it all, I won't have to remember exactly!

At any rate, are you guys interested in these posts - or would you rather I start a separate mommy blog and keep this strictly vet medicine related? I do plan on talking about being a vet and being a mommy when I go back to work, but I'm asking more about the early day aspects. Would it bore you and drive you away from my blog? Please let me know!