I am sad to say that I think this blog is reaching its natural end.

For the past 7 years, I have kept The Homeless Parrot. It has been a part of my veterinary student life, my intern life, and now my ER veterinarian life. After 3 years as an ER veterinarian, the stories are starting to sound the same.

Motherhood, a full-time job, and outside interests have kept me from blogging. That and I just don't need the catharsis of words that I once did. My catharsis is now a 20 pound, red-headed ball of mischief that has just recently learned to crawl/scoot, grab the cats, and clap her hands. I don't find myself NEEDING to sit down and write anymore, although I hate to think of the stories that I will forget as a result of this. If there is no need, then there is no drive - hence the 1-2 week pauses in blogging.

Thank you for reading. Thank you for your comments. The support of readers I have never met has been invaluable during some difficult times. Blogging has been wonderful. There are several of you that I consider friends, though I don't know your last names, and we have never met.

If you'd like to keep in touch, my email remains the same.

On how to be a better veterinarian

Self improvement is something I work on constantly. This week brought a new experience that helped to open my eyes to ways that I can improve my interactions with owners.

Wednesday morning, we had a doctor's meeting. I'd been up all night at work, obsessing over my dead patient. I was tired, demoralized, and just stressed in general. I stopped by the house prior to the meeting to pick up Evaline. I wanted to let my husband sleep in, and she is usually a very good baby out and about in public. The first half of the meeting, she happily ate her egg and entertained herself. Toward the latter half, she became fussy and tired. I had my husband come pick her up, and the meeting continued.

When I got home, she was napping. It became apparent when she woke up that there was something wrong. She was glassy-eyed and very lethargic. Her cheeks were flushed, and she seemed to be breathing with effort. My husband thought I was hallucinating from being overtired and emotional, but I know my baby. I knew she was sick. We packed her off to the pediatrician's office quickly.

I was a mess quite honestly. I was overtired, emotional, and stressed about work. And to see my little Smoosh become so ill so quickly was terrifying. I started to cry. I cried the whole way to the doctor's office and while we waited. Worse case scenarios kept running through my head.

The doctor that saw Evaline was not her normal pediatrician. She was kind, thorough, did an excellent physical exam, and listened to my concerns. Despite my somewhat overwrought tears, she listened to me and took me seriously. She didn't make me feel silly about how upset I was. She explained her physical exam findings and then she went over differentials with me. She answered all my questions carefully and seemed to really understand my anxiety. Despite being fairly confident in her diagnosis (bronchiolitis likely secondary to a virus), she sent me for a chest X-ray. She knew it would assuage my worries.

I learned a lot from her mannerisms. What Evaline has is a common disease of infants. History and physical exam are usually sufficient for diagnosis. She's probably seen it a thousand times. Yet, she never made me feel rushed or as if I was overreacting about a fairly common illness (which I was).

It reminded me that although I see bite wounds and hit by cars and heart failure dogs all the time at work, most people are seeing it for the first time, and it's scary. It reminded me to talk to people gently. To listen to owners' fears and concerns. To answer questions and take the time to make sure my recommendations are understood. It reminded me to be compassionate no matter now silly or over the top an owner's reaction may be.

To that end, I wrote a thank you note to her and her staff saying pretty much all of that.

Evaline seems to be on the mend, although she is still hoarse. Me - I will be on the mend once Monday rolls around and I can forget I'm a vet for 9 days.

General demoralization

Due to scheduling of one of my colleague's yearly continuing education, I ended up working 5 nights in a row this last week, including the Friday, Saturday, and Sunday shift of Memorial Day. Come Monday morning, I was exhausted to the point that I was having trouble thinking clearly. I had several very ill animals that need intensive, detailed care. It wore me out. By the time I left Monday morning, I was done.

Tonight, I had to work again. Tired and sorely missing my family time, I dragged myself to work. And of course, of course, of course, I would be faced with a patient of mine from this past weekend suffering a severe postoperative complication that may or may not be my fault. It lead to the pet's death this evening. Only a professional necropsy (done tomorrow) will tell if I am to blame.

On top of that soul crushing occurrence, I am dealing with ridiculous, needless technician drama that is making me crazy. I've barely seen my daughter in a week. I've barely had more than 10 words with my husband. He is basically solo parenting for all intents and purposes right now - other than breastfeeding duty, which obviously still falls to me.

This feels like the hardest job in the world, and right now, I hate it.

Ruminations on being a working mom

**Caveat: after re-reading this, I realize I meander a bit. Sorry about that. I DID title it "ruminations."

There is a tremendous amount of guilt associated with being a working mother. I try very hard to not allow guilt to creep into my thinking. It's a useless emotion. If one feels guilt, one should change the situation about which one feels guilty. If that's not possible, the guilt must be eradicated, as it is doing no good and quite possibly doing harm.

I love my daughter. She is the sun in my sky. I wake up every morning excited to spend the day with her, excited to see what new sound she'll make, or how she'll look when she's rocking back and forth in an effort to crawl. I take her to the grocery store with me just because I love her company. I think of things to do with her that will make her happy. She's pretty much the best thing that has ever happened to me.

Now, I'll say that I love my job. It's obviously a different sort of love. If I had to choose one or the other, the choice would be absolutely clear to me. That said, I still thrive at work. I'm good at what I do. I care about what I do. I have a great workplace that - while it has minor shortcomings - overall is a fantastic work environment. I do something that matters to people. There are days when I wish I could be a stay-at-home mother, and there are days that I realize just how difficult that job is. Spending all day, every day with a small person who cannot communicate effectively and who cannot hold an adult conversation, and further, who needs a LOT of care and attention, is exhausting. I admire stay-at-home mothers of kids, because it IS a job. And a difficult one to do well.

I work long hours. REALLY long hours. When I am away from my daughter, it is for long stretches of time. My shifts are around 15 hours typically, and I do several in a row. Thus, when I am home between shifts, I am sleeping most of the day. I "care" for my daughter by sleepily nursing her in bed, then turning her over to her father, so that I can rest more.

I am the primary breadwinner. I take a great deal of pride in my productivity - in the fact that I can provide for my family. Oddly enough, despite growing up surrounded by many family members with advanced degrees, I never really saw myself doing much in life. I certainly never envisioned that I would be a doctor. Financial woes were a part of my childhood, and ever since I was old enough to really understand finances, I was convinced that I would struggle with them. It's hard for me to believe even now that I own a house, provide for my daughter, have an IRA and savings, and am not in danger of a financial catastrophe. There are days when I still can't believe that my daughter will grow up with different worries than I did.

There are days when I realize that my being a doctor will be a fantastic model to my daughter should she decide she wants to have a career. If she decides to make her career being a mother and a wife, then I will be just as thrilled.

Those things make me feel good about being a working mother.

What doesn't make me feel good is watching my 8 month old daughter's face fall as I leave for a 15 hour night shift. Or calling to check on her around bedtime and hearing her wailing in the background, wondering where her mommy is to snuggle up against her and offer the breast. My daughter needs me in a very intense emotional way right now, and I am often not there for her. I wonder if this will somehow damage her emotionally, if she'll grow up not feeling safe and secure and loved.

Then I think how ridiculous that must seem to others. I breastfeeed my baby girl. I sleep with her. I wear her when the opportunity presents itself. I take her with me on errands, talk to her while I cook, kiss and hug her and stroke her face at every single chance. I don't take one day for granted with her. I watch her grow and I'm excited for the little girl, teenager, and woman she'll become, and my heart aches for the little girl that she is already leaving behind. How can a child raised with that ever be insecure? Not to mention that her father dotes on her as much as I do. Oh and don't even get me started on her grandparents - who are mad about her - and her aunts and uncles and cousins. And then of course, every single stranger we meet who has to come up and talk to my daughter.

*Sigh*

I can't do it all. I can't do it perfectly. I can do it the best I can, and I can hug and kiss her every single time it crosses my mind. And she'll come out ok, I think. She'll know she's loved. She'll know she can do whatever she wants when she grows up - be it have a family and a career, or make her career that of motherhood.

It will all be ok. That's what I tell myself when I hear my daughter crying over the phone.

I know you're dying to see pictures

Of my sweet almost 8 month old baby! My best friend from vet school is in town. We went hiking today, and the sprout had a wonderful time. So did we.

Sundries

I'm off work for 9 days, so my time has been spent cleaning the house and hanging out with my daughter and husband.

My old man cat is home and doing well. He had surgery on Tuesday night. 50+ stones were removed from his bladder (small ones). His kidney values are better, and he is improving. He'll eat for us at home, but he is incontinent at the moment. It's not surprising with the stretching and moving of his bladder, and it will hopefully resolve in the next few days.

I'm late starting, but I finally got around to planting my garden. Well, half of it anyway. It's hard to do anything that takes focused attention for more than 1 hour when you have an 8 month old. I got one of my boxes planted (the tomatoes and peppers). I have 1 more box (cukes, squash, and maybe something else), and then I have a patio container that I'm trying out this year. We'll see how it goes. I'm feeling ambitious and plan on planting a late summer/early fall garden this year too - trying to grow lettuces and broccoli, etc.

The sprout is growing like a weed. We are still doing mostly baby led weaning. I'm not giving her big slices and chunks of food. I just can't do it. I am letting her feed herself though. She gets whatever we are having chopped into smaller, more manageable pieces. Tonight, she had meatloaf, baked potato, and avocado. She really likes feeding herself and loves to eat. It's fun to watch her, and my anxiety is eased by taking this middle-of-the-road approach to feeding. We've ditched the rice cereal, and we never did purees.

Today was her first experience at the swimming pool. We (meaning I, I think my husband had reservations about her tiredness level) made the mistake of taking her to the pool when she was over-tired. I didn't realize how tired she was until I saw the pictures. Her little eyes were so red! She hates taking naps, and she will fight them with every bit of strength she has. Getting her to nap is a constant battle. At any rate, she didn't seem to know what to make of the big, warm bathtub, but I finally elicited a few smiles from her by blowing bubbles in the water and "chewing" on her feet. We'll try again tomorrow maybe.

This weekend promises to be fun. One of my best friends from vet school is flying in to spend the weekend with me and visit with Evaline. I can't wait to spend time with her!

Lastly, to all that were concerned about the man that stabbed the puppy, he was arrested on the spot. He was already on his way to jail when I saw the dog, so thankfully, I didn't have to deal with that aspect of it. North Carolina has Susie's Law so hopefully this non-human will suffer consequences for what he did. I also hope that his daughter is taken away from him. If I get any further information, I'll let y'all know what happened.

That's all for now! I hope everyone has a good weekend.

Bummer

I worked all weekend. We were very busy, so I didn't sleep on Friday or Saturday night at all. Once upon a time, I would've been able to handle that no problem. No longer. I blame my personal miss on my own cat on this lack of sleep. I noticed on Saturday morning that my old man cat seemed sluggish. He wasn't very active, just kind of lying around. I filed it away for further consideration. I noticed it again Sunday, but again, I didn't think too much about it. He wasn't vomiting or straining in the litterbox or vocalizing, so I wasn't too concerned.

Then, Monday afternoon, I caught him straining to urinate on the dog's bed. He has bladder stones. I KNOW this. I should've palpated his bladder when I first noticed the sluggishness. But I didn't. I snatched him up then and felt his abdomen. His bladder was HUGE. It was also rock hard. He didn't make a peep. That's highly unusual. Most blocked male cats I see at work are screaming their heads off. Their bladders hurt that badly. Archie never made a sound.

At any rate, he's at work now. He has a urinary catheter in place, and his urine is the color of cherry Kool-Aid. He is in acute renal failure secondary to obstruction. I'm hopeful that I caught it soon enough for it to be reversible. Hopeful that my slow-on-the-uptakeness has not caused him any permanent harm.

*Sigh* Why do the cobbler's kids always go barefoot?

Hell hath frozen over.

I'm still in a state of shock.

The other night, during a spectacularly busy shift, I was presented with a large breed bitch in labor. Without giving specifics, I will say that the dog's breed was one usually associated with people that have lower incomes. At any rate, she was having trouble getting her puppies out. She'd been actively pushing for 4 hours, and no puppies were forthcoming. A sac had exited the vagina and ruptured, but no puppy was to be seen.

As I've mentioned ad nauseum, I hate dystocias. The owners never have any financial plan for difficulties with birthing, the patients are often poor specimens to be breeding, are generally unvaccinated and not on heartworm preventative. I see it every. Single. Week.

So I went into the room with serious annoyance. I recommended the usual after examining the dog and finding weak contractions and no puppies in the birth canal - X-rays to count puppies and look for an explanation as to the cause of her difficulties, as well as ultrasound to assess heartbeats, puppy movement, and the abdomen in general.

The owner readily agreed. I was delighted to find that the dog was vaccinated fully and received monthly heartworm preventative. X-rays showed 12 puppies! The first puppy, attempting to make its exit, had an accumulation of gas bubbles around it on X-ray. This is consistent with fetal death and decomposition. I discussed this with the owner and made the dreaded recommendation. C-section. I did this fully expecting to hear the "how much is this going to cost me?" snarl, followed by the 4 hour attempt to scrape up enough money for a discount/el cheapo c-section.

To my shock and awe, the owner produced the necessary funds without complaint. As we discussed the finances, she said to me, "I save money in case this happens. It's irresponsible to breed if you don't have the money to deal the problems that can arise."

I'll be honest. I had to scoop my jaw off the floor. I want to erect a statue to this woman in the lobby.

I weep for humanity

I suppose that if I work long enough in this field, I will see everything. Last night brought something new and terrible.

Sleeping soundly at 4am (the ER was slow), I was awoken by my technician informing me that there was a hysterical woman in the lobby, the police were here, and a dog was bleeding.

Sure enough, it was so. Why was the dog bleeding, you may ask? The male owner of the dog wanted to teach his toddler son a lesson about disobeying daddy. So he picked up his son's helpless, 5 month old puppy and STABBED it repeatedly. The dog suffered 14 stab wounds from nose to tail, most penetrating the thorax and abdomen.

The poor dog was in pain and shock, shivering but able to lick my hand while I examined her. Her wounds were grievous. She needed an exploratory surgery of her abdomen and possibly her chest. The woman that brought her in had no finances, so we had to euthanize the puppy.

I weep for humanity. I really weep for that little boy.

Public service announcement

In the last couple of months, 3 children (2 infants, 1 toddler) have been killed by dogs. You can read about it here, here, and here. Warning: these are graphic and horrifying stories.

I have briefly posted about this before, but I want to reiterate it yet again.

The real tragedy is that these needless, horrible deaths could have been prevented.

No dog should ever be left unsupervised with a child. EVER. PERIOD. And I'm not just talking about Huskies and Golden Retrievers and Rottweilers. Even small dogs can pose a threat to a newborn baby. A Pomeranian killed a newborn in the bassinet by grabbing its head (several years ago, I believe). Small dogs pose a threat too. And when I say supervise, I mean that any child should be supervised by an aware, sober, responsible ADULT any time a dog is in the room.

Dog are wonderful additions to families. They can grow up with children, offering companionship and important lessons in how to treat those who cannot speak for themselves. They can also teach responsibility for another living creature and respect for others. I don't think that having dogs automatically equals creating a dangerous environment for your child. I own a 75 pound Doberman.

But I know without a doubt that I would never trust her alone with my daughter. She is the sweetest, most docile Doberman I have ever met. Once, as I was holding my cousin Stephen, he reached over and poked her in the corner of the eye. His finger went into the socket about 2 knuckles deep. She didn't even flinch. She's that forgiving. And STILL, there is no way I would trust her with my child unsupervised. Why? Simply this - I have nothing to gain by leaving my child alone with my dog, but I have everything to lose.

So, here are the things I think every parent should know and do to prepare a dog and a child for dog/child encounters.

First, every parent should learn the warning signs of an anxious dog that might bite. This site: Liam J Perk Foundation has several excellent links on the warning signs in dogs. (As an aside, if you don't want to cry, don't read Liam's story. If you need more convincing, read it). The ASPCA has an excellent article on dog body language.

Secondly, every child needs to be educated on how to interact properly with familiar AND strange dogs. Sure, you can be vigilant about monitoring dog/child interactions at home, but what about when your child is walking home from the bus stop and meets an unfamiliar dog? All children need to learn how to interact in this situation. The ASPCA has some good links on this subject.

Third, every dog owner should set up and maintain a "safe place" for the family dog - somewhere the baby can't reach by crawling and where the dog can feel safe. Crate training is essential for this sort of thing. They are indispensable for any number of behavior problems and are absolutely a must when large groups of people visit. They create a safe habitat for dogs.

Fourth, large groups of people are not good places to mix children and dogs. There is too much going on, and everyone assumes everyone else is supervising. When planning for a party or holiday gathering, dogs should be crated or otherwise removed from the excitement. This is when having a crate becomes very important - again, a safe environment for the dog.

In summary, dogs are great additions to a family. But having a dog, like anything, is a responsibility that must be taken seriously and never lightly. There is no reason to trust your dog with your child's life.

Animalicious - updated link

**Hopefully the error is fixed. Try the website again. I added a new link to the right: Animalicious - brought to you by some great veterinarian minds. One of the authors is Tony Johnson, a very funny, irreverent board-certified emergency/critical care doctor at Purdue. The page is in its infancy - but I recommend you check it out. It's at the bottom of my blog list for veterinary stuff.

On motherhood and anxiety and first morning smiles

Motherhood continues to amaze, astound, and terrify me.

In case it doesn't come through loud and clear on this blog, I suffer from some anxiety issues. It can range from mild anxiety to panic attacks, depending on the day and the trigger. I've mentioned it here and there before, but I never really dwell on it. I've occasionally thought about taking medication to help with it, but at this juncture, medication is really out of the question for me. I breastfeed exclusively, and I cannot take the risk that even a fraction of the medication passes to Evaline.

Motherhood is wonderful. I love my daughter so much. When she goes to bed at night, I miss her. I look forward to the next day, not knowing what it will hold in terms of my daughter's growing communication skills, movement (she's already trying to crawl), eating habits, and everything else. Each day is a surprise and a gift.

That is tempered by staggering (at times) anxiety. We've been slowly introducing solid foods now that she is 6 months. It has been causing borderline panic attacks. I have a deathly fear of her choking. I'm not sure where it comes from, but every time she eats, I start to panic inside. My heart was set on doing baby led weaning, but quite frankly, I'm too afraid. We're going middle road. No purees or baby food. She gets whatever we have for dinner, mushed into baby-gumming chunks. She's handling it great, and she loves to be involved with dinner. My anxiety is slowly abating, but I'm sure something else will take its place.

It all boils down to control. I am a control freak. And now I have this tiny person, whom I love with every fiber of my being, whom I would die for, and she depends on me to keep her safe. It's terrifying. Utterly terrifying. I need to control everything to make sure that I am absolutely keeping her safe at all times. There are things I should control - a pool alarm for her grandparents' unfenced pool is reasonable. Making sure that the dog is never left alone in the room with the baby is reasonable. Making sure her toys are child safe is reasonable. But smashing every particle of food into atoms is not. She has to grow up, and I can't (nor should I) protect her from the whole world. Sometimes I can't sleep at night because I envision all the terrible things that could happen to her. All of the terrible things I read about in the news. I wind up getting angry at myself for focusing on so much negativity. Worrying does nothing about tomorrow, but it certainly robs today of its pleasure.

I hope that with time this abates. When I'm not anxious, it's wonderful. When I am, it can be nightmarish. Some of my friends have suggested that this may be a form of PPD. While that may be true, I return to the fact that due to breastfeeding, I will not be taking anti-depressants. This is after a few days of heavy consideration.

Lest you all worry, I am fine. The anxiety comes in spells. After spending the weekend with my mom, in-laws, and other various relatives who all raised children successfully and watching them interact and feed Evaline, I am a great deal less nervous about introducing foods. I'm dealing with it.

And something to end the anxiety post with: Evaline sleeps in our bed at this time for a variety of reasons. Every morning, I am woken up by soft patting of my face with small baby hands. When I wake up and look at her, she gives me the biggest, gummiest baby smile you have ever seen. There is nothing so sweet as being loved like that. Nothing.

If you read my last post, you will hear about Snook - a dog in which I possibly missed an important diagnosis.

The owner wants a refund of his money, and honestly, I am torn over what to do.

Snook did die, yes. When he left my clinic however, he was completely stable with normal vitals. His back hurt, yes, but he had no signs of imminent death. I have double and triple checked the medications he was given, in the event the I had overdosed him, but that is not the case. No, Snook died from something else.

The owner claims we killed his dog with an overdose. When I explained that it was not the case and went over the medications with him, he switched tactics. Now he is claiming that he had no idea prior to leaving the clinic with his dog that Snook would die.

I can't argue with him. It's true. Even I had no idea Snook was in any threat of death, or else I never would have sent him home.

Here's my problem(s). Medicine is an art and not a science. IF Snook died from meningitis, a spinal tap would have been necessary to diagnose it. This would only be done by a neurologist. I did offer referral, but the owners, thinking the back pain and seizure activity were separate (as I did) elected to wait on this. Once Snook died, the only way to confirm what caused his death would have been a necropsy (animal autopsy). The owners did not pursue that and instead buried him.

Thus, I will never know for sure what killed Snook. My guess is meningitis, but truthfully, I have no idea. Whose to say that Snook didn't go home and get into something toxic?

My husband made a great analogy. It's like taking your car in for a transmission repair. You pick it up, drive it for half a day, and then it dies. Instead of taking it back to the place where you had it fixed, you sell it to the junkyard. Then you ask the repair place for your money back.

Was it a faulty transmission and poor repair? Possibly. Is there any way to know for sure? Absolutely not.

Thus, I am stuck. The owner wants his money back, but his reasoning is unclear. I am very sad that Snook died; I feel terrible. Did I miss something? Quite possibly. But there is no way to know for sure.

What I do know is that I sent a dog that looked stable and mostly healthy other than neck pain out the door only to hear that he was dead 8 hours later.

What do y'all think?

Deep thoughts by Dr HP

I've been ruminating a great deal lately on the nature of being a good veterinarian and how one goes from being a cutting edge, up-to-date practitioner to an out-of-date, "good 'ole doc," ready with the steroids and antibiotics and not so much on the diagnostic testing and advanced treatments.

Recently, I was faced with a patient that I feel I failed. "Snook" was a 3 year old rat terrier. He'd been seen at his vet a week prior for neck and back pain. Therapy with standard anti-inflammatories, pain medications, and muscle relaxants had not relieved his pain at all. In fact, the owners reported that he was worsening, despite his medications. The night he saw me, he suffered a seizure. Snook had never had seizures before, so this was very alarming to the owners.

Snook presented to me around 10pm. He was alert and responsive. He was able to stand, but he had a very pronounced hunch to his back. He was whimpering. I examined him carefully. He didn't have a fever, and I could find no other significant abnormalities other than back pain. Snook responded to me and didn't seem to have any cranial nerve deficits.

As I talked to the owners, it became apparent that they were not properly resting Snook. They'd allowed him to jump on/off furniture. Anyone with any personal experience in back pain can tell you that there is nothing worse for it than overdoing it! One of the most important components of treating back pain in dogs is strict, strict rest - in a crate or kennel. The reason? If you give a dog a few doses of pain medication, they start to feel miraculously healed, so they start acting like dogs again, and voila! back pain returns.

Further, Snook had absolutely no other signs of serious illness - just the seizure. So, I assumed the 2 things were not related. I didn't make a crucial connection between back/neck pain and seizures. I gave him a shot of opioid and muscle relaxant/sedation, tweaked the medications his vet had dispensed for him, recommended very strict cage rest, and sent him home.

The next morning, he was in a coma. He went to his vet, and he had another seizure on the way. He died about an hour later, having never become conscious again. The veterinarian who saw him claimed that he was "over-sedated."

Beside myself, I combed through his record, through all the medications I gave and prescribed, and double-checked my medical record against our controlled drug log, as well as the hand written amounts given by the technicians. Everything was right.

And then I realized that this dog likely was suffering meningitis - either GME or NME. It explained the non-responsive pain, the seizure, the progression to stupor, and death. And I missed it. Not that it would have mattered much - as the patient died within 8 hours of seeing me. GME/NME are terrible diseases which are almost always fatal, even with aggressive, early care.

What it did to me though was really got me thinking about my mindset. How I approach cases. How I might miss things. How I might be becoming stuck in my ways, and how I might not be learning anymore.

See, I work predominantly alone. On the weekends, I overlap with the other doctor, but it's a short time period. I have only been out of school for 4 years. I still have so much to learn. I keep up with my journal reading, so I am exposed to new knowledge that way. I attend the required CE yearly and actually go to all of the lectures that I can. I haunt VIN (Veterinary Information Network). I post cases on VIN when I am confused or have no answers and seek to learn how to better my diagnostic approach and treatments.

And still, is it enough? In a few years - will I be 'ole doc? Stuck in my ways? Afraid of change?

It's something to think about...

Well, it's been a week again. My apologies. It's been a big week for us though! After 7 years of very diligent work, my poor, work-beleaguered husband has finished his PhD. He is now Doctor Homeless Parrot. He defended his thesis last week. I attended, and I must say that he did a brilliant job. He made complicated, pure mathematics almost - ALMOST - comprehensible to even me. His advisor commented to me that it was the best thesis presentation he'd attended (and he's seen many).

Afterwards, we had a party to celebrate my husband's triumph. It was a great gathering of friends and family, and it went according to my plans smashingly. He then followed it up with some much needed whitewater kayaking, then Easter dinner with my family.

We arrived home Monday to find that my very old SUV needed YET AGAIN, about 1k in repairs. Seeing as how it is 14 years old with 215,000 miles on it, and we just spent $1600 getting it repaired 6 months ago we decided it was time to let it die.

Thus, we are now owners of a 2008 Honda Odyssey. I have officially joined the mom cult. I have a Mininvan! I won't lie, I love it.

In baby news, we have 2 teeth busting through and a fussing girl to show for it. She still manages to be the sweetest baby on earth though. Motherhood continues to be amazing. Exhausting, frustrating, but utterly amazing.

With that, I will leave you. I started back to work tonight after my typical 9 day hiatus, so veterinary stories will be coming.

New blogger is buggy. There are no spaces in my first post with new blogger (see below). Hopefully this will be fixed soon. In the meantime, sorry for the difficult reading.

I think I'm starting to repeat myself

This blog might be reaching the end of its lifespan. I feel like my posts are starting to repeat themselves. This past weeknight brought the following cases - all in ONE 2 hour span.

Room 1 - 3 eighteen (barely) year old kids and their unvaccinated 12 week old, weak, lethargic, vomiting, anorexic puppy. The first words out of their mouths to my technician: "DO EVERYTHING TO SAVE HER!" Yeah. Here's your estimate for the emergency exam room fee ($95) and a parvovirus test ($55). Suddenly they're all, "uhhhh...we need to think this over..."I never even see these kids, but instead go into Room 2.

Room 2: people that make Deliverance extras look normal. Obviously, no branches in the family tree. They'd brought in their very stoic, junkyard dog who turned out to be very sweet. He'd had his foot run over by the lawnmower. A cursory glance showed that the bones of his toes were exposed on top. They had $140 and were declined for CareCredit.

Room 3: A dog that had been mauled by the neighbor's 2 junkyard dogs (not related to the junkyard dog from Room 2). The kicker? Said mauling victim was unneutered and free-roaming. This was the SECOND dog that the owner had allowed this to happen to. The first was euthanized because the owner could not afford to treat him. This dog was likely facing the same fate, as the owner had $200 MAXIMUM to work with and was also declined for CareCredit.

In the midst of all this, in waltzed a woman with $60 (not even enough to cover the exam room fee). Her cat had a stick protruding FROM her abdomen. Kitty was essentially shish-ka-bobbed.

*SIGH* In the end, I administered pain medications, a strong sedative, an injection of antibiotic, and cleaned and carefully bandaged the lawnmower dog's foot. He was to see his vet in the morning. In my heart, I know he is somewhere with a filthy bandage and a rotting wound. I'm trying to be optimistic, but my good 'ole common sense knows better.

Room 3 got a dose of strong pain medications so that I could examine him (he screamed anytime his neck was touched). His wounds were deep and the tearing of the muscle was significant. We shaved them, cleaned them thoroughly, administered an injection of antibiotics, and sent him home with antibiotics and pain medications. He was also to see his vet the next day for follow-up care. He is likely either dead or somewhere suffering a slow death of sepsis.

The shish-ka-bob kitty's owner declined humane euthanasia and took the cat home with the plan to return with funds. Someone was "wiring money to her at Wal-Mart, and she'd be back." We did not see her again. (Shocking, I know).

The kids with the likely parvovirus puppy elected to leave without an exam or treatment, as they didn't have any money.

And people wonder why vets get burnt out?

Careful believing what you read on the internet

This will tickle my readers, I'm sure. It was an excellent reminder of why you should take internet reviews of services with a grain of salt. Heck, with LESS than a grain of salt.

A couple of weekends ago, a woman presented her dog after being hit by a car. The dog was stable, but she couldn't use one leg, and she was in a great deal of pain. My colleague recommended xrays, a little bit of bloodwork to assess for internal injury and bleeding, and the like.

The owner flatly refused, called us money-grubbers, and took her dog home without anything further.

About 24 hours later, she called back (I was on shift). She told the receptionist that her dog had not urinated in a full 24 hours. She was also "in a lot of pain" and wouldn't rise. At that point, my receptionist strongly urged the woman to bring the dog in, as it sounded serious. The owner refused. She then demanded to know what she could treat her dog with OTC for pain. My receptionist again told her to bring the dog in, that she could not make OTC recommendations. The owner then flew off the handle, accusing us of being monsters and stealing. She went on and on until finally my receptionist hung up on her.

The following day, she posted a gigantic rant on our FB page - calling us twisted monsters and threatening to bring us down. Asking how we dared to state we care about animals when clearly all we want to do is steal from people?

You know what this woman did next? She took her animal to one of our shareholder clinics down the road...AND SHE ABANDONED IT. Yep, dumped the injured dog on the doorstep and never came back.

And we're the twisted monsters?

Baby update :)

She's pretty much the sweetest, happiest little girl in the world. I love her so much!

Bad outcomes can't always be predicted

Every time I look, another week has whizzed by me.

I had a sad, sad case recently. It broke my heart on a great many levels. It was a busy weekend. In the midst of it, I was presented with a young cat that would not get up. She attempted to bite us every time we touched her. Her gums were pale, her temperature was low, and her heart rate was very high. I picked her up and grimaced as a I felt a giant, firm knot protruding from her abdomen. I suspected she'd suffered abdominal trauma based on what I felt and had a hernia of abdominal organs.

Xrays confirmed my suspicion. Part of her intestines were herniated. Given her condition, I suspected the intestines that were out of the body were strangulated and dying. Her bloodwork showed evidence of systemic infection. Her blood pressure was low, her white blood cell count was low, and her blood sugar was dropping. We stabilized her prior to surgery - normalizing her blood pressure, body temperature, and pulses. She looked pretty good prior to surgery. Once in the abdomen, I removed the 4 inches of dead intestine and sewed the ends together. Unfortunately, That wasn't the worst of it.

The hernia was caused by 2 penetrating bite wounds. And they had done more damage than just the hernia. The entire subcutaneous space (between the skin and the muscle) was filled with pus and necrotic, infected fat. Further, the muscles had started to die from trauma and infection. The smell was absolutely horrific. It took me 45 minutes just to clean out all of the nastiness between the body wall and the musculature.

Post-operatively, my patient would not recover from anesthesia. Her blood pressure and heart rate plummeted. Her pupils became fixed and dilated. We aggressively resuscitated her with fluids, giving her crystalloids, colloids, and vasopressors. She rallied briefly, but then began to decline again.

I knew her deterioration was likely due to the surgical agitation of all that necrosis and infection. The strangulated guts had been pinched off from the abdomen. When we opened it and removed them, a mass of inflammatory mediators were released into the blood. Further, opening and removing the necrosed and infected fat also likely released all kinds of nasty cytokines and free radicals into circulation. She was also probably suffering from a coagulopathy, as we'd had to give her large quantities of Hetastarch to help maintain her blood pressure.

It was all stacked against her. She absolutely required surgery to survive, yet surgery tipped her already barely stable septic condition into full on septic shock and DIC. It was a damned if you do, damned if you don't.

I was left having to tell her "owner" - a girl of 7 - that I couldn't help her kitty anymore. She was very brave, but tears rolled down her face. She didn't really understand. She only knew her kitty was terribly terribly sick. It made me so sad. I saw my daughter in her face. Imagined the first time my daughter suffered a loss. It made me so sad that I couldn't save her cat.

In the end, she kissed kitty on the head, and left with her daddy. I was left to give the only solution that I could offer kitty for her terrible injury.

It was bitter.

The difficulty of parrots revisited

I had a thoughtful comment on this post that I wanted to share with everyone. I also wanted to share somewhat of a rebuttal. The comment:

"I agree that birds require work. And I definitely agree that people need to be properly educated before adopting one.

However, this post and its comments seem to make a HUGE assumption that dogs, cats, and horses, because they are "more domesticated" than birds, automatically make them better pets for everyone. And that's definitely incorrect.

I work at two different vet hospitals. One sees dogs and cats; the other sees birds. And I see the same range of personalities, behavioral problems, health issues, and bad owner related problems at BOTH hospitals. What I also see is this: whether its birds, dogs, or cats, if the animal is properly taken care of throughout its life by knowledgable owners, the animals work completely fine as pets.

That's also why I think its short-sighted to compare birds to tigers. Birds can very easily be properly taken care of by individuals and families if they know what they're doing. Tigers not so much. Their needs are even difficult for zoos to meet.

If you're going to keep an animal as a pet, you need to know what you're getting into - regardless of the species. Lets also not forget that dogs, cats, and horses weren't always domesticated. And I'm sure that, when people did start keeping them, not everyone thought they were 'meant to be pets.' And yet, here we are.

Kudos to finding a great interim solution to your own bird issue. But please, I'm sure you also know that there are people in your same position, having trouble with a new addition to the family and a pet that isn't handling it well....but that pet happens to be a dog. It happens all the time, and not just with birds."

Scott makes excellent points about our responsibility to pets that we want to adopt. Education and seeking out knowledge are key to taking care of pets. His point is absolutely important. It is also one that I think all of my long-time followers would say I harp on frequently. Taking care of your pets, whether through vaccinating, spaying/neutering, or behavior therapy as needed is something I harp on here repeatedly.

But, first off Scott, you are wrong in your first statement about cats/dogs/horses being "good pets for everyone." I certainly don't think everyone should own pets. I was merely making the point that these species have lived in domesticity for thousands of years.

I also disagree in the overall assumption that birds are suitable pets and more akin to dogs and cats then tigers. It is plain fact that parrots sold in this country have only been domestically bred since about the late 70s, early 80s. Thus, they are barely removed from their wild counterparts. Some breeding birds used EVEN NOW are wild birds. Cats, dogs, and horses have been domesticated for thousands of years. Birds are still - for all intents and purposes - wild animals. They are much more akin to tigers than cats.

Further, Scott states that even zoos have difficulty meeting the needs of tigers. The same is true of birds. We haven't even really figured out how to properly feed the hundreds of different species of birds. A commercial pelleted diet sounds like a good idea in theory - but when applied to the variety of birds that eat it, eh - not so much. Macaws need higher fat diets (eat many nuts in the wild), greys are ground foragers for seeds and berries, etc. Each species has its own individual needs, and each type of parrot is a totally different species. Dogs are all one species. Chihuahuas can breed with German shepherds. Macaws cannot breed with cockatoos. This incredible variation makes knowing enough about even one species a challenge.

Scott, you state that birds can be very easily taken care of by people with knowledge. That is precisely why I wrote this post. I am very knowledgeable about birds. I read many, many books prior to adopting. I worked around birds. In vet school, I spent 3 years doing avian research, as well as spending my extra rotations in vet school in the exotics ward. I am better prepared than most bird owners out there to handle the demands of a large parrot. And yet still, I am struggling mightily with my parrot at home. I think you missed the point of the post overall, or maybe you just disagree.

I have met people with parrots that did EVERYTHING they were supposed to do, and the parrot still developed feather plucking behavior or incessant screaming. I have seen owners at their wits' end because no matter how much time, attention, and behavioral modification they tried, their bird was still melting down. Even the best bird owners sometimes can't help a neurotic bird. Why? They are wild animals, and we cannot always meet their needs, because half the time, we don't even know what those needs are. Does the same happen with dogs and cats? Yes. There are some animals that cannot be helped. I would wager that it happens much, much less frequently than with birds, though.

I stand by my prior statement that birds are not suitable pets.

And I absolutely agree with your last statement that many people struggle with this with cats and dogs. I've seen my fair share of people wanting to euthanize a cat that is now peeing all over the house after the addition of a new baby. Or the dog that is old and grumpy and snaps at kids. I'm well aware of that problem. Those problems are not - however - the result of innate wild behaviors and unsuitability of that species, but rather individual personality traits of that dog or cat.

Parrots are still wild animals, and wild animals do not belong in homes.

A fun one

So, instead of death and destruction, something fun.

An owner brought in her perfectly normal-looking, healthy female cat (about 2 years old) named Claus. According to the owner, Claus was left unsupervised in her son's room. Her son had been playing with his Nerf darts. When the two came back into the room, the tips of the darts were still there, but the foam ends were gone. The owner insisted that Claus had chewed them off and eaten them.

I suggested that perhaps Claus had just relocated the ends to underneath the sofa, since cats aren't notorious foreign body eaters. No, she insisted, Claus had eaten them! I suggested an xray to assess the stomach with plans to go from there. I fully expected to see an empty stomach. I was fully wrong. The stomach was PACKED with foam darts.

Now the dilemma. Cats - unlike dogs - are extremely difficult to induce vomiting in. A dog - give a shot of apomorphine and stand back. A cat - well, a cat may or may not respond to a dose of xylazine, a dose of Dexdomitor, or a dose of hydromorphone or morphine. Cats just like to scoff at whatever works in a dog.

Crossing my fingers, I gave a dose of Dexdomitor intra-muscularly, then jostled poor Claus around as vigorously as I could ("vigorous external gastric massage" is what we've taken to calling this technique). About 10 minutes later, the kitty obliged us and vomited (YAY! success!). To our amazement, Claus vomited up this mess:

Thankfully, xray showed that they were all out of the stomach, and Claus went on to likely eat other, equally odd objects.

Trite

I hate how good owners always seem to have pets with terrible diseases. It's such a cliche in veterinary medicine. Probably in human medicine as well.

Last week, I was presented with a nice, small breed dog late at night. His owner was concerned because he'd suddenly developed very, very bloody urine, as well as lethargy. As I examined the dog, my heart sank. He was dehydrated, depressed, and his gums were yellow-tinted, as were his eyes and inner ear pinna. Jaundice coupled with bloody urine usually means that the body is hemolyzing its own red blood cells (IMHA - see sidebar).

My testing confirmed this terrible disease, and I delivered the news to his owner. IMHA carries a fairly grim prognosis. Partly because it's a really bad disease and partly because it can be very, very expensive to treat. Owners often end up euthanizing because the cost is too great.

In this case, the owner wanted to try, so we started with a blood transfusion. Unfortunately, my patient rapidly hemolyzed it, leaving him more anemic than when we started. He also developed evidence of disseminated intravascular coagulation.

After much soul-searching, his owner elected to euthanize him. I can't say it was the wrong decision, given the rapid deterioration, but it was still such a downer. His owner loved him very much and cared for him very well.

Life is not fair.

And another ones goes by...

Another almost week has flown by me. I have excuses. My best friend from high school, who married my husband's brother, went into labor Wednesday night. At 12am, we jumped into the car and made the trip to Knoxville to be there when my new nephew joined the world. She, like me, is an avid believer in natural birth. This being her first, I wanted to be nearby to lend support as needed. Unbelievably, her labor lasted only 6 hours. Unfortunately, three of that was pushing, and all of it was enormously painful back labor. She did amazingly though and was successful in her quest to bring her baby into the world the safest way possible. He is tiny and adorable. He weighed 7lb 15oz. I was utterly shocked at how tiny he seemed. Ms Evaline is weighing in around 15-16 pounds, all of it adorable baby chunk. At 5.5 months, I cannot believe she was ever that small. It makes me sad that she is already growing so fast!

The trip was very short, as I had just Wed and Thurs off. Tonight, I am back at work, nose to the grindstone. We've been busy with out share of cases tonight. Truthfully, I cannot wait for the weekend to end so that I can go back to Knoxville and help my best friend and BIL with the new addition.

Babies are so wonderful! I'm already crazy to have another!

Good owner, good cat = bad disease

It's an axiom of veterinary medicine. Good owners with sweet pets is always going to equate to something bad when they are ill. This past weeknight was no exception. I was presented with a sweet, older cat (11 years old). She'd been fine up until about a week prior to coming to seem me. The owner noticed that she'd been hiding frequently and less social than usual. Then, a couple days prior to seeing me, her appetite had dropped off. Then she'd stopped eating completely. She wasn't vomiting or having diarrhea, but had no interest in food, and she was becoming increasingly anti-social.

The owner was distraught. He explained he had a young child at home (15 months). He wasn't sure when his cat's appetite had dropped off, and he felt badly that he hadn't been "paying enough attention." He immediately stated that whatever testing was necessary, he would do.

I examined kitty and found a cat in good body condition. Her heart and lungs sounded good. She was mildly dehydrated. Her lymph nodes were normal in size, her skin was dry and free of ectoparasites. Her oral exam was unremarkable. Her gums were nice and pink, she had no string at the base of her tongue, no significant halitosis, no oral ulcers. Then I palpated her abdomen. Right in the middle, I held in my hand something lemon-sized and firm. I wasn't sure what I was holding, but I knew it wasn't good.

I hoped against hope that it was a colon filled with stool, although it really didn't feel like that. Or maybe an enlarged kidney compensating for a previously failed kidney. In my heart of hearts though, I knew what it was.

Xrays and ultrasound confirmed my suspicion. The kitty had a large mid-abdominal mass. It didn't appear to be associated with the spleen, liver, or kidneys, and I suspected it was growing from her gastrointestinal system. Gastrointestinal lymphoma is a very common cancer of cats.

I delivered the grim news to the owner and discussed options - exploratory surgery with removal if possible, histopathology if not (or euthanasia on the table, if appropriate), palliative care for a suspected cancer, or euthanasia.

He struggled with the decision, as he really, really loved his cat. In the end, he asked me my opinion quite bluntly. Without knowing what exactly the mass was, I couldn't give him an accurate prognosis. So I told him what my gut said. It was bad. After much deliberation, he elected euthanasia. With tears in his eyes, he held his kitty and said good-bye.

Afterwards, he kindly allowed me to necropsy his cat so that I could see what exactly I was feeling. I found this.

I aspirated cells just to confirm my diagnosis, and it was indeed a GI lymphoma. It was satisfying to know that I was absolutely right. It was a bitter satisfaction though, given the outcome for a kind father and his sweet cat.

Sorry that I keep going AWOL without warning. Time gets away from me like it never used to do. I guess that's having a 5 month old (yes, 5 months!), a full-time job, and traveling whenever I'm not working. My last 9 days off saw me visiting my best friend and her husband (my husband's brother) in Tennessee. She is due any day now, and I went to help prepare the house for the baby (cleaning). I also cooked and froze food for her. She's officially ready to pop now. Prior to that, it was my husband's grandmother's funeral, and before that, home with the family. I scarcely have time to breathe.

I have a good albeit sad case to post, which I'll do below.

The difficulty of parrots

Parrots, in my humble opinion, are not good pets. Unlike dogs and cats and horses, whose domestication goes back thousands of years, pet parrots are only a few generations removed from the wild. Prior to the late 70s, if you purchased a parrot, it was likely caught in the wild and sold into captivity. That is changing with stricter laws about this kind of thing, but those earlier times lead to parrots coming into homes as pets that were still completely wild animals. For the most part, they remain so, even if they are bred in captivity.

As a result of this, they are very difficult pets. Stripped of their natural flock, they must adopt a new one - namely the family within which they live. But just because they adopt a new family doesn't mean they adopt new ways of living. They still behave as if they live in the wild. They try to find mates (often you), they nest, they lay eggs, they greet the morning sunrise and sunset with piercing calls, and generally act like - well, wild animals.

I try to convey this to people whenever they talk to me about how much they want a bird. It's hard to tell someone that has their mind set on a certain pet what a bad idea it is, but I still try. Parrots are not good pets for most people. Any parrot rescue can attest to this fact. They are overrun with poor, feather-plucked, neurotic, screaming birds dumped by families that were overwhelmed by what is simply normal parrot behavior.

See, I knew all this prior to getting my parrots. I did careful research before adopting each bird. I knew about species' individual characteristics, personalities, and quirks. I made careful decisions. I fed the right diets, bought the enrichment toys, made sure the birds were uncaged at least 75% if not more of the time. I'm the ideal birdie parrot.

And yet, even I was unprepared for the changes wrought by the addition of our child to the house. My African grey, Titus, has not adjusted well. First, the birds had to be moved from their privte room into a more common area of the house. This leads to less bird "quiet time" - which is essential for normalcy. Unfortunately, I didn't plan that when buying this house. So, first, he is sleep-deprived. Despite covering his cage and keeping it dark where they sleep, they are still aware of us and make noise when they hear us up and about.

Secondly, I just don't have the time to pay attention to him that I once did. Between full time ER work and full time mommy hood, the hours in my day are limited. Thus, he is in his cage more than he is used to.

Thirdly, the presence of competition for my affections has caused him great unrest. He sees me as his mate, and he doesn't appreciate the competitor.

All of this has lead to incessant screaming in my house since the baby was born. He screams all day - if he can't see me, but can hear me, if I go into the kitchen without him, if I shower without him, if I walk out the door to get the mail, or if I'm sleeping between shifts. It's a high-pitched, ear splitting, repetitive scream that goes on and on. My blood pressure probably gets into the 200 range easily when it happens.

It has steadily worsened over the last 5 months, leaving me worried about the next 40 years of this. My nerves were getting frayed, and I was starting to think I would have to find him a new home. This thought made me feel absolutely terrible. I knew what I was getting into when I adopted a parrot. I'm a veterinarian for frick's sake, I'm not Joe Schmo random bird buying consumer.

I digress. A beautiful situation has worked out. My office manager loves parrots. She offered to let Titus come and live at the clinic. I thought it would be a bad idea, giving his vocalizing. Amazingly, the opposite is true. Due to the heavy socializing I gave him as a younger bird, he is making friends with everyone at the clinic. He is out of his cage all day, has loving attention from many of my technicians, gets lots of (healthy) treats and attention. Many of my techs who have never even expressed interest in birds are surprisingly fond of him. His screaming has dropped to virtually nil. I get to see him when I work and interact with him, and he is a totally different, happier bird.

In the long run, I foresee him coming back to live with us when we move next. We'll have to have a bird specific room so that he can get his beauty rest. In the meantime, I could not ask for a happier resolution to a problem that has been eating at me for months now. It was hard to even write about it, but I want to serve as a cautionary tale. Parrots are difficult pets, and they are not for most families!

Doing the right thing sometimes feels bad...

I was faced with a very uncomfortable situation this past weekend. A woman called late one night telling us that her dog was in agonizing pain. She wanted to bring her in. The owner confessed to my technician that originally took the call that she was "heavily medicated herself" and shouldn't be driving. My technician urged her to find someone else to drive her but to no avail.

Over the course of the next 1.5 hours, the owner called multiple times because she was lost. She'd been to our clinic numerous times over the years, so she should have been able to find us. She drove up and down a strip of road not one mile from us for 40 minutes searching for our sign.

In the course of this, she spoke to two of my other technicians, and she told them both the same thing, she was too messed up to drive. She even told one that she'd almost rear-ended someone!

When she got to our clinic, it was obvious that she was altered.

I handled her pet's problem, and then asked her point blank why she was driving. She explained that she'd had a stroke recently and was on several medications. She was a genuinely nice lady, and I felt terrible for her. But she also posed a threat. I told her that I wanted her to call a family member or a taxi service. She would not.

With that, I was forced to call the police. They came and gave her a quick sobriety test. She did not pass. The officer was very kind and told her to call a family member. She was resistant to this. I went into the room and offered to call her a cab. She declined, smiling sadly at me and telling me that "function just wasn't coming back after the stroke like it should've been." I truly felt sorry for this women. She reacted so kindly and understandingly to me, even though I called the police on her.

In the end, she called her sister to pick her up. The officer left, and she went to the front desk to check out. Then her true stripes showed.

"I can't believe you did that," she hissed at my technician. "I will never be coming back here again. It was none of your business."

My tech responded that anyone on a public road endangering lives was certainly her business. The woman made no reply and refused to say another word until she left.

Maybe I'm being soft. Maybe she didn't really have a stroke and was just messed up on drugs. She told me that the only thing she took was her stroke medication, but she told the officer that she'd taken some lorazepam. Still, I felt bad about the whole situation. The only consolation is that I would have felt worse had she driven away and killed herself, her dog, or someone else.

Mastitis much?

I haven't seen a good case of mastitis in the last year that I can recall (also a preventable disease if you spay your damn pets! But I digress). This weekend I saw two. I won't lie, my heart and breasts ached for these poor dogs. On the bright side, I had actual firsthand knowledge of their pain, as well as what would help relieve it. I probably shared more information with the owners than they wanted, but I was able to offer firsthand advice on what would help their poor, painful, miserable dogs feel better. It was very satisfying.

The first owner was a lovely woman. I confess that intitially, I was quite annoyed with her. After talking about her dog's mastitis, she confessed that she didn't know the first thing about puppies or handling maternal problems. In my head, I was thinking, "then why did you go and breed them, foolish woman?"

Turns out, she adopted the dog from the humane society 2 months previously. She had lost her dog of 14 years to likely cancer and had carefully chosen a new companion from the shelter. Turns out, her new companion was pregnant! Poor lady. Thankfully, the shelter was helping her out and taking the puppies when they were weaned and ready to go. I personally think they should have been footing the mastitis bill too.

The weekend was fairly quiet otherwise. The day time shift was apparently busy, but I mostly sat around, read my book, played Words with Friends, and made sure the clinic didn't burn down.

I hate the reproductive tract

Of all emergencies, I loathe reproductive emergencies the most. They are all preventable. Dystocias, pyometras, prolapsed penises, uterine torsions - they could all be prevented with spaying and neutering. Further, almost without fail, the owners of these disasters have no financial resources. Last night brought no exceptions.

I was tired and a bit down. My husband's grandmother died somewhat unexpectedly on Monday morning. She was 98, so it wasn't totally out of the blue. She was healthy though - no cancer, diabetes, stroke, or heart disease. Other than moderate memory problems, she was really the picture of health.

We had to leave Wednesday morning to make visitation on Wednesday evening in Tennessee, so I was hoping for some sleep. It was not to be.

A pregnant large breed dog showed up at midnight. She'd had some signs of labor - panting, anxiousness, and restlessness. Then she had pushed out a sac. It ruptured and spilled green fluid everywhere. No puppy followed. No contractions followed. She continued to be anxious, but she had no signs of labor.

Now it was midnight, and the owners were worried. Oh, and by the way, we are on disability and have $300.

WHY? Why are you breeding your dog if you don't have the finances to deal with complications? When my husband and I decided to have a baby, we made a careful savings plan to cover my maternity leave. We didn't just willy-nilly get knocked up. And I had to pay $2500 for the birth as part of my insurance plan. We had that money and expected to have to pay it. That's the way it works.

At any rate, I was limited to taking 1 X-ray. On it, I saw no evidnence of fetal or maternal obstruction. Next would have been an ultrasound to determine if the pups were alive and if they were distressed. The owners didn't have the money for that. I did it anyway, because I couldn't, in good conscience, give the bitch oxytocin without knowing if the puppies were distressed.

I gave them their options. Wait until morning to see their vet and have a csection then or try oxytocin to stimulate contractions. They chose the latter. Luckily for me, it worked. It took 4 hours though. After that time, we had 5 live, healthy puppies. It was then 5:30am, so any hope of sleep weas essentially gone.

I'm grateful that I could help the bitch. Having recently given birth myself, I can attest to the fact that she was probably very anxious and in pain. It was a relief that I could get the puppies out with medical intervention, because had it come down to a csection, I highly suspect Her owners would have euthanized her. They didn't have the money.

Moral of the story: plan before you breed! Unexpected complications arise, just like in human births! Most of the time, things go smoothly. When they don't - it will cost money!

Thoughts on the future

My long term plans have been on my mind a great deal lately. As my husband approaches the end of his PhD after many years of work, it looks like we will both be gainfully employed at the same time. What a novel idea! After 12 years of marriage and nearly 20 years of advanced education combined. It's hard to believe it's really going to happen.

With this development, we've really been trying to figure out where we're going and what we're doing. I have a great job here. It's stable, pays well, has good benefits, and for the most part, the kinks are worked out with employees and whatnot. We own a house that I have decorated and that we really like. The real estate market is also terrible. Overall, I am happy. It's not close enough to family, and the area is not gorgeous like other parts of NC, but since Evaline was born, we have seen family continuously. Thus, we know it is possible, despite the 3.5 hour distance.

Unfortunately, options for my husband are very limited. He wants to teach at a small private college. He also wants to live somewhere that is closer to home and more naturally beautiful. Kayaking and spending time out of doors are very important to him, and there just isn't much in the way of that in this part of the state. This part of NC lacks the beauty of the farther west areas. Ideally, we would wind up in Asheville or that part of the state. The problem? Finding a job for me.

The veterinary field is in turmoil, jobs are few and far between. Further, I want to do emergency work. GP just isn't an area of interest for me. I fear boredom! Also, I love ER medicine and feel that this is where I should be. I'm afforded long blocks of time off which I can spend with my family. Most GPs I know work as much or more than I do.

So, my mind is constantly turning to where we'll be in 6 months. I can honestly say that I don't know the answer to that. Whatever happens, I know that my husband is ready to start his career, and I am ready to settle somewhere and not move again for many, many years. We've Been here for 3 years this July, and I have truly loved the feeling of being "settled." Wherever we wind up next, it's going to be a long-term move! It's really exciting, because despite the fact that we have a child now and a "real" life, these changes make it real. We're going to settle somewhere and stay!

Out sick

I hate missing work, and in the last 2.5 years, I haven't missed work for illness or any other reason. I cannot shake this bug! I worked last night. We weren't busy, but I saw a handful of cases and didn't lie down until 1am. By then, I felt terrible. Around 5am, I woke up, overwhelmingly nauseated again! An episode of vomiting followed. Today, I remain weak and tired, with little appetite. I stayed home tonight. Thankfully, my colleague was willing to work for me. Here's hoping that this bug goes away soon!

Sometimes the customer is right

Even in veterinary medicine.

Clients that self-diagnose their pets always drive veterinarians crazy. It's just a pet peeve, and I'm sure it occurs in every industry concerned with "repair." But sometimes, we need to make sure that our personal annoyances don't get in the way of listening when someone has something important to say.

Several months ago, a worried owner brought me a perfectly healthy, happy looking puppy named Trigger. She insisted that Trigger had swallowed a very hard rawhide and that it was stuck in his throat. Now, owners think this all the time - that their pet is choking on something. Half the time, it turns out to be a cough of some sort, other times, the pet is nauseated.

So I examined Trigger. He was bouncy and alert. He did not cough when I palpated his throat area. He was not nauseated. His abdomen didn't hurt when I palpated it. I questioned his owner as to why she thought he had swallowed it. Per her report, Trigger was gnawing on a 6 inch long, very hard rawhide. Seconds later, it was gone, nowhere to be found. Shortly afterwards, Trigger began to cough lightly and act uncomfortable.

I assured her that his physical exam was normal, and he showed no signs of having anything stuck in his throat. She seemed so concerned though that I told her we would be on the safe side and conduct some xrays.

So, we took xrays. I quickly glanced at them and said, "nope, no rawhide." Then I looked closer. Was there something? My technician looked at the films and laughed. "There's nothing there!" But still ... Something so faint. Artifact of positioning? Or rawhide?

I went back and forth with myself, then decided to give the puppy a mouthful of barium (a contrast agent that shows up bright white on xray). Sure enough, the contrast perfectly outlined a rawhide chew toy stuck half in/half out of the stomach! I couldn't believe it. Most normal dogs would be vomiting with the rawhide positioned as it was. This puppy felt fine.

3 hours later and a visit with the internist for endoscopy, and the rawhide was easily removed. It was an important reminder to listen to your clients. Sometimes they provide you with valuable information!

Well hello, Mr Norovirus

If you've seen the news in North Carolina, you've likely heard about the norovirus outbreak. Commonly called the "winter vomit bug" or "the cruise ship flu" - it's a nasty little virus that leads to a bad gastroenteritis.

The husband and I are in Tennessee this week. He to meet with his thesis advisor, and me because I am hosting a baby shower for my best friend on Saturday. She is due March 1. Yesterday, I woke up feeling dizzy and weak. I tried to take a shower to see if it would help. 30 seconds into it, I knew I was going to be sick. Thus, the husband and I spent all day yesterday being miserable. Luckily, it's a short-lived bug. I am mostly recovered today. So far, the small fry doesn't seem to have contracted it. Here's hoping that she doesn't.

Also luckily, my FIL is a doctor. So he brought home a shot of Zofran and some phenergan for us. I can hold down food now, but I'm still weak and tired.

On that note, I think I'll take a nap, since Evaline is sleeping.

The importance of patterns or, a treatise on how I didn't see that coming (again)

Part of being a good doctor is learning to recognize patterns. This can generally be agreed upon by medical professionals. A more subtle part of being beyond good and being excellent is realizing when to ignore the patterns so that you don't miss something really important.

Examples of recognizing patterns. A 2 year old, female spayed Poodle presents for generalized lethargy, vomiting, and diarrhea. Addison's disease is an important rule out. An owner that calls and reports that his Great Dane is retching non-productively retching. Think GDV. A 7 month old Labrador comes in for vomiting and not eating, think foreign body in the stomach or small intestines.

These are the patterns that every veterinarian learns. They are important. But they are "stereotypes" as it were. And as with everyday life, these stereotypes are sometimes wrong.

This morning, my colleague saw a patient. It was a 14 year old Golden retriever. She'd been vomiting off and on for a week. She briefly responded to medications, then she started vomiting again. My colleague treated her symptomatically and sent her home.

At the beginning of my shift, the dog came back. She had deteriorated through the day. Her breathing was labored, her heart rate was sky high, and she looked generally I'll. Her case perplexed me a great deal. Her heart rate was so high that I initially thought she had a primary cardiac disease. She was also having an intermittent arrhythmia. Xrays did not support heart enlargement, heart disease, or pulmonary edema, but they were suggestive of aspiration pneumonia. This often occurs in vomiting patients.

Bloodwork was equally unrewarding, being very non-specific and unexciting. I tried a dose of a beta blocker to slow her heart rate. It was unsuccessful. Thus, I assumed that her heart rate was related to something else - pain or dehydration. I administered a dose of pain medication, and the heart rate dropped immediately.

I returned to my xrays, suspicious. Then I talked to the owner and gave her the news. In a 14 year old, vomiting dog that is not responding to therapy, cancer has to be the #1 consideration. The dog's xrays looked consistent with an upper GI obstruction. Masses of cancerous origin can cause this.

After much discussion, we decided to explore her dog's abdomen. Guess what we found? A foreign body stuck in the middle of the intestines! It was a very nasty linear foreign body, but we were able to remove it and leave all of the intestines behind.

The lesson? Don't rule out differentials just because of patterns. A 14 year old dog can eat a foreign object just as easily as a 14 month old dog. Thankfully, I knew I was missing the cause of her problems and kept looking and probing to find the answer. Had I just gone with patterns, I likely would have told the owner cancer until proven otherwise. Instead, we took her to surgery, found the problem, and fixed it.

Work and family

I received this comment yesterday:

"I am a new reader to your blog and like reading about your vet work. Very interesting--but I would also love to hear how you are juggling motherhood and work. How is your family adapting --esp. your baby?"

The timing couldn't have been more perfect, as I've been meaning to do an update on the work/motherhood situation.

So far, the transition has been mostly painless. It's definitely hard being away from Evaline for long hours of work. I miss her terribly when we're slow. Being busy helps more, as I have less time to think about my darling little girl.

The transition for her has also seemed to be relatively painless. When I started back to work, I was really worried about 2 things - her lack of a schedule and her refusal to sleep well anywhere other than in the bed with me. Amazingly and luckily, those things naturally and quickly worked themselves out when I went back to work. She started to self-regulate and now has a pretty normal schedule of going down for the night at around 10:30-11:30 and sleeping till anywhere from 5:30-7:30. At that point, she wakes up and wants to eat, then sleeps again for several hours. We've had a bit of regression on the sleeping at night lately, but I've read that this is very common at 4 months.

As to sleeping in bed with me, she still does that when I am home (it's the only way I get to snuggle my sweet baby when I'm working long night shifts), but she has no trouble moving into the cosleeper bassinet next to me at night. I find the cosleeper to be helpful when I need good, deep sleep. Evaline is a wiggler and tends to kick and fidget in her sleep. If I need to get a good, restful 5 hours, I nurse her to sleep, then move her to the cosleeper. If I'm off work however, she just sleeps with me.

She does tend to get a bit more fussy with her daddy than with me, and she seems to know when I am leaving and get a tad upst. Otherwise, she is doing great at home with my husband. He is in the final death throes of his mathematics PhD. He has been working on his PhD for years, and it is almost done. Right now, he's struggling to get work finished when I am at work. The baby takes up all of his attention when I'm gone. Luckily, we have family members (my mom, his mom) who are kind enough to come down on a semi-regular basis and help with childcare so that he can prepare for his defense.

Working and pumping has also been going pretty well. There have been a couple of situations in which I've had to go too long between pumping sessions. This has lead to some very painful clogged ducts. Otherwise, I am currently able to pump enough to keep up with her, and I am able to find time to do it at work. That's the beauty of winter in the ER - we're usually slow (although that has not been the case lately).

As to the "sleep deprivation," I find it no more serious than bottle raising 3 kittens at one time. Truthfully, ER has prepared me well for this kind of sporadic sleeping schedule, and other than the first month and a half (when I wasn't even working), I haven't felt like a zombie. I feel like I'm getting enough sleep at home, and I've been able to catch a few hours of sleep every night at work (except for my last weekend on, which was hellish).

All in all, I couldn't ask for a better, smoother adjustment period. It has definitely been hard, and there are nights (like last) where I miss her so much that I call my husband 6 times in 6 hours, just to see how she is doing.

Interestingly, my approach to work is evolving rapidly. I used to be very, very serious about my work. In such a way that I was very one-dimensional in my approach to things. Having a baby and something outside my work to focus so intently on, it has helped me broaden my focus. I think it's having an effect on my medicine. It's hard to explain, but I'll work on it. I'm also not so annoyed with clients and stupid situations anymore. When it boils down to it, I do what I can within the constraints clients place on me, and there's really not much else I can do. It's strange to think that having a child would change this for me, but it really has.

Overall, I'm happier and much more well-balanced. My technicians have all commented on the change. They think I'm glowing. Motherhood does that to you. I love her so much that sometimes my heart is stilled with astonishment.

Well, that's a first

I was recently presented with a bloated Great Dane. Gastric-dilatation volvulus (GDV/"bloat") is extremely common in this breed. It requires immediate surgical intervention if the patient is to live (see sidebar for more information). The first step beyond physical exam in diagnosing the GDV is a lateral xray of the abdomen. When I took the lateral xray on this patient, it wasn't the typical xray we always see (called the "double bubble"). It was definitely a torsion, but it just looked wrong for some reason. I filed that away for later consideration and went to talk to the owners about surgery. They agreed to proceed.

Now, I do GDV surgery fairly often. In fact, I did one on my last week of work. It went swimmingly - textbook, "caught it early" GDV. This one...far from textbook.

The first clue came when I opened the abdomen. In a typical GDV, the omentum is on the top, as the stomach is torsed 180 degrees, pulling that tissue up and over itself. So it **should** be the first thing you see. Instead, I was staring at a massively engorged spleen. Hemorrhage came pouring out of my incision. My heart did a little skip as my brain computed. What the heck was going on?

I lifted the spleen up as gently as I could, and as soon as I did, blood started to pour out of it. It was then that I realized I was looking at a 360 degree GDV. This is a much less common manifestation of GDV in which the stomach twists completely around. The complete torsion pulls the spleen up and over, so it is the first thing you see when exploring the abdomen. In doing so, the spleen is often torn off of its blood supply, leading to massive hemorrhage.

I'll tell you guys, that was the fastest I have EVER done a splenectomy in my life. That spleen was out in about 4 minutes. Afterwards, the surgery proceeded fairly routinely, as we passed a tube and deflated the stomach.

Our patient recovered mostly uneventfully and will hopefully go on to live a normal and long life. And now I have an explanation for the weird xray. Hopefully should I see one again, I'll be ready for it!

Oh and if you missed it on the sidebar

I am now a contributor to a new blog called "Veterinarians Behaving Badly." It's hilarious. Check it out.

Bad, bad choices

Few things irk me as much as people making repeatedly stupid choices when it comes to the medical care of their pets.

I was transferred a case recently that was terribly sad because it was SO avoidable. A mastiff bitch was seen at her veterinarian and underwent a c-section. 8 puppies all told were present, 5 alive, 3 dead.

The dog (Lizzy) had started passing thick, dark, foul-smelling and bloody fluid from her vulva on Thursday morning. Thursday night, she had a puppy. It was very dead. Nothing else happened for 12 more hours. Friday morning, she had another puppy, also dead. The owners still did nothing. Saturday morning, she was very lethargic and had passed no further puppies. The owners gave her a shot of "something" provided to them by a friend. It was supposed to induce labor, but the owners had no idea what the medication was called.

Late Saturday, still no puppies and a progressively more lethargic dog. Finally, the owners decided a trip to the veterinarian was in order.

A c-section was conducted on Lizzy. After surgery, she was not recovering very well. The veterinarian did some testing and discovered that Lizzy was likely suffering septicemia (systemic infection). This is not an uncommon sequelae to prolonged dystocia. He transferred the patient to me for continued care.

Unfortunately, it became apparent at presentation that the owners had spent all of their finances on the surgery. They applied for CareCredit and were granted an increase of $1200. Unfortunately, care for Lizzy for only 1 night would run in the $700-800 range.

It was time to have a frank discussion with the owners. Lizzy was likely going to need 2-5 days of hospitalization, her prognosis was very guarded, and the bill would likely become expensive rapidly. We discussed the finances involved. The owners really had the extra $1200 AT MOST and that was stretching it for them.

After much soul-searching, they decided euthanasia was the best option. When I knelt beside Lizzy, she lifted her head and looked at me, then sighed and rested her head on my knee. This was the first sign of responsiveness we'd really seen since she presented. My heart hurt a little. Her predicament was utterly preventable.

First, the owners shouldn't have bred her if they weren't prepared financially to deal with the possible ramifications, and secondly, had they taken Lizzy to see her veterinarian when the first problems were noted, the sepsis would very likely have been avoided. Now, the only one really suffering from the owner's terrible decision making was Lizzy herself.

I felt terrible euthanizing her. Hopefully, she is somewhere running through a field of green grass with puppies that have gone on before her.

Change in contact info

My new email address: homelessparrot@gmail.com. I really hate hotmail.

A difficult diagnosis comes too late

A few weeks ago, my diagnostic skills were really challenged, and unfortunately, I failed the test. By the time I made a diagnosis, it was far too late for the animal to be saved.

On a very busy weekend, as I was running around like a headless chicken, I was presented with an older, large breed dog named Triton. He had been normal the previous evening. When the owners came outside, they'd found him collapsed in a pool of blood. They rushed him to us quickly. The owners reported that he'd been losing weight for several weeks, but otherwise he was healthy. He was a well-cared for and well-loved dog. The night before he became sick, he had been able to get out of his enclosure at home. This was the first time he'd ever gotten out. He was gone for an hour, and the owners had no idea what happened in that hour of time.

On physical exam, I had a quiet/depressed dog with pure hemorrhage coming form his rectum. There was no history of vomiting or other GI signs. His heart rate was very high, his body temperature was slightly low, his pulses were poor, and his gums were muddy and pale.

We started shock treatment on him - fluids to help stabilize his low blood pressure, a sedative to help him calm down, re-warming, and other treatments. Bloodwork was conducted and showed significant dehydration - a PCV of 71! and a normal lactate (see sidebar). The kidney, liver, and all other values were pretty much normal.

My tentative diagnosis was hemorrhagic gastroenteritis (see sidebar) secondary to Triton getting into something the previous evening. He started to respond well to treatment. His temperature came up, his blood pressure improved enormously, and his gums became pink and moist. With this excellent response to therapy, I assumed I had my diagnosis and need look no further. Xrays were on my list of things to do as he stabilized, but since he was doing so well, I elected to wait until there were more hands on deck to do them. He was placed in his cage on a strict hourly vitals and blood pressure monitoring schedule. One of my techs watched him like a hawk, and he seemed to be doing well. Blood pressure stayed normal, temperature stayed normal, and he rested quietly.

3 hours later, my technician went to take him for a walk. He took 2 steps, urinated, and collapsed. My technician put him up on our wet table and got a round of vitals, including blood pressure. They were rapidly worsening again (the bloody diarrhea had stopped).

Perplexed, I started at him, trying to see what I was missing. I requested the ultrasound machine, which was rolled to me. Ultrasounding his abdomen, I saw a lot of free fluid - never, ever a good sign. Tapping it with a needle, I got a syringe full of foul-smelling, brown fluid. Uh-oh. It smelled like intestinal contents.

On the spot, I told the owners that surgery was needed ASAP to find out where the fluid was originating. In the meantime, we were conducting more bloodwork. Results were still fairly unremarkable, and lactate was still normal. They never hesitated, and within 20 minutes, I was opening his abdomen.

What I found devastated me. Triton had a mesenteric volvulus. This occurs when the root of the mesentery twists on itsef, often several times. As a result, most of the small intestines are deprived of their blood flow. The small intestines were completely dead. Not part of them. ALL of them. There was nothing I could do, no salvaging Triton's intestines. He had to be euthanized on the table.

So, why did I miss the diagnosis? In a dog of his breed and with his clinical signs, a mesenteric volvulus should have been on my list of differentials immediately. It wasn't. So, why?

First, the getting out for an hour and running around was a total red herring. It had likely nothing to do with the formation of the volvulus, but I was distracted by this piece of history. He had never gotten out before, so naturally I assumed it was somehow related.

Secondly, I've seen 3 other cases of mesenteric volvulus, and in none of them was the patient ever able to be stabilized well. Since Triton initially responded well to our shock therapy, I assumed we had likely identified the underlying problem and were treating appropriately.

Third, of the other 3 I have seen, all of them have had excruciating pain on abdominal palpation. One of them almost bit my face off when I touched her belly, she was in so much pain. This dog didn't seem to be painful at presentation.

Fourth, Triton's bloodwork reflected dehydration but not much else. The normal lactate threw me off. Why was lactate normal in a dog with significant oxygen deprivation to the intestines? Because they were so twisted that the blood within them with an incredibly high lactate couldn't get back into circulation. Drawing blood from the front leg did not reflect what was happening in the strangulated intestines.

Lastly, I didn't take xrays immediately. A dog with hemorrhagic diarrhea that severe, I SHOULD have taken xrays immediately. Instead, since he responded so well to treatment, I elected to wait until we were less busy, and I had a technician to do them. At the time, xrays didn't seem emergently necessary.

The one bright spot in the whole dismal case? Mesenteric volvulus has a mortality rate of almost 100%, even when caught by the very astute (obviously not me) within minutes. The small intestines cannot handle being cut off from their blood supply for even minutes. Thus, by
the time the problem is found generally, there is nothing that can be done.

It's cold comfort to me. I should have known or at least had some idea.

You can bet though that I won't miss it next time.