Thursday, March 29, 2012

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?

Wednesday, March 28, 2012

Baby update :)

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

Sunday, March 25, 2012

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.

Monday, March 19, 2012

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.

Sunday, March 18, 2012

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.

Thursday, March 15, 2012


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.

Saturday, March 10, 2012

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!

Sunday, March 4, 2012

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.

Saturday, March 3, 2012

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.