Back again

It was a fun but exhausting weekend. We left Thursday around 11am and arrived in Destin, Florida at 9pm. It was a long drive, and I think I saw the inside of every single gas station bathroom between Florida and North Carolina. All in all, the trip wasn't too bad. My wonderful husband did all the driving, so that I could sit like a lazy, pregnant sack of potatoes.

I've only been to the panhandle of Florida once before that I remember - as an 11 or 12 year old for church camp. I didn't recall how beautiful the sea is there. Destin especially was gorgeous. The sea is blue-green - like Hawaii but not quite as brilliant. The sand was like sugar.

It was a beautiful weekend, and my friend was the most gorgeous bride I have ever seen. We enjoyed time on the beach, around the pool, with good friends (including one I had only ever met on Facebook and now blogs too). There was lots of beer, champagne, and liquor. Of course, I could not imbibe - but my husband made up for both of us.

Lots of random people rubbed my belly, which didn't bother me much. Everyone loves a pregnant woman. I didn't get enough sleep, and by the time the wedding was finished, my ankles were enormous. I also burst some capillaries in my legs. So, all in all, I probably overdid it. It was all in the name of my friend's wedding though...and totally worth it.

Back to work tonight, veterinary stories to come.

It's the small things

I found curtains for the nursery - just when I was starting to despair! It seems like such a small thing, but it was really bugging me. I couldn't find anything I liked. Last night, we went to Bed, Bath, and Beyond to get a wedding present for this weekend, and I happened to swing by the curtain section and find the perfect pair!

The frames above the bed are black and white photos of Jim's grandmother - the one after which we are naming our daughter.

We leave the day after tomorrow for my vet school classmate's wedding. I am matron of honor. It's going to be a long, long drive (10.5+ hours, then add in stops for my pregnant bladder and to stretch my legs). It will be a quick weekend - what with driving all day Thurs and coming back Sunday. I'll probably be AWOL for a bit, as I have to go back to work Monday night.

Rewarding!

I love a rewarding case - looking at a patient and knowing that my intervention and the care of my technicians saved its life. It is one of the things that is most awesome about ER medicine. One of my favorite things to treat - hands down - is anaphylaxis. I see this at a minimum of once a month. I am kind of an anaphylaxis magnet at work, for some reason. Maybe I'm just good at recognizing it, who knows? It took me a long time to realize that anaphylaxis was out there and to start looking for it in my inexplicably collapsed and poorly responsive patients.

Around 6am this morning, a medium sized dog named Lily presented to us. She had been normal that evening, then jumped on her owner's bed, collapsed, defecated and urinated on herself, and then proceeded to start vomiting.

When she got to us, Lily had barely palpable pulses. Her gums were a muddy grey-pink color. Her heart rate was 240 (normal 90-120). She was breathing hard and seemed very weak. Her blood pressure would not register. She had a rash along her ventral abdomen, and her body temperature was low.

Her owner was a disabled, elderly lady with $250 to her name. This is certainly not enough to treat a nasty anaphylaxis. On a weekend, these cases run into the $1200-2000 range. I was not hopeful when she applied for CareCredit, as she was on disability. I was decidedly wrong, as she was approved for $1800. We had already started working on her dog at that point anyway.

Within an hour of administering epinephrine and Benadryl, starting aggressive fluid therapy to bring her blood pressure up, administering dextrose for her low blood sugar, and re-warming her, Lily's heart rate was down to 120, her gums were pink and moist, and she was standing in her cage and showing interest in her surroundings.

When I left her this morning, her vitals were stable, her blood pressure was 120, her blood glucose was normal, and she was maintaining her body temperature on her own.

It is always immensely satisfying to take a dying dog and raise it Lazarus style from near-death. It really makes my job worth it (despite being up all night last night due to patients and having nearly constant Braxton-Hicks contractions all morning).

Sad case

Last night, a nice country man brought in his new puppy. He had obtained this puppy about 6 hours prior, and since then, she'd been bleeding profusely from one side of her nose. I couldn't see a cut or any other explanation for the bleeding without sedating her. Unfortunately, the new owner had about $120 to his name. I recommended we spend the money wisely on sedation for a nasal and soft palate exam.

Both were unremarkable, and I could find no explanation for the bleeding. I questioned the owner at length about the new puppy - any trauma? any chance of rat poison exposure? He said no to these and then elected to take the puppy home for monitoring. The bleeding continued unabated.

Prior to leaving, he called the original owner. He casually mentioned that yes, the puppy DID have access to DCon rat poisoning. Come to think of it, the dog had been pooping green pellets for the last few days!!!

I told the owner how concerning this was and recommended running at least one clotting time test (a PT). This is the first of the 2 clotting times to become increased when an animal ingests rat poison.

Most modern rat poisons are anti-clotting drugs. They exert this effect by inhibiting an important enzyme that is responsible for the reduction of vitamin K in the body. Without this enzyme, vitamin K dependent clotting factors (clotting factors 2,7,9, and 10) do not get made. As a result, the body becomes unable to clot blood. This takes about 3-6 days to occur AFTER the rodenticide has been eaten.

At any rate, the owner agreed to run a PT. It was so high as to be out of range on our machine - indicating a severe clotting disorder. It appeared that our little puppy was suffering rat poisoning.

Unfortunately for the puppy, the new owner did not have the finances to provide treatment (fresh frozen plasma transfusion to replace the deficient clotting factors and vitamin K supplementation to provide the body with what it cannot make). Instead of doing anything, he took the puppy back to the original owner. He declined to even take vitamin K.

I can only hope that the original dimwit has the puppy treated, but I suspect it will lie in a lot somewhere and die a slow death of internal hemorrhage. It was an all around bad scenario.

More nursery stuff

I am not crafty in the slightest. My mother scrapbooks, makes handmade cards, sews, makes dolls, and the like. She often accuses me of being adopted due to my lack of interest in visiting Michael's fabric store, AC Moore, or Hancock's. So, when the creativity stirs me, and I actually create something, I get really excited. A couple of months ago, I bought some white picture box frames at Ikea, and some fabric swatches from AC Moore. The plan was to frame the fabric in the colors of the nursery. I figured it would be one of those things I never got around to - mostly because I'm not meticulous or crafty at all.

But I did it! I am so proud of my wall of art!

Nursery Stage 1

My wonderful husband painted the nursery for the past 2 days, and today, he put together the crib and "dresser" (i.e. Ikea Expedit bookcase). There's still much to do - hang artwork, get a new light fixture to replace the circa 1995 brass one, pick curtain rods and hang curtains, pick a glider, and on and on - but it's taking shape. That's exciting. I'm pleased with our Wal-Mart online Baby Mod crib. For $200, it was a good deal, it's made of wood, and it feels nice and sturdy.

Who knew that babies need so much stuff??

People make me KRAZEE

Some funsies from this weekend:

A woman who looked suspiciously like she did either crack or meth (or both) presented her very sweet, old Chihuahua for a "bleeding face." Said Chi had not been to a vet in 4+ years, was not on heartworm preventative, and had received no vaccines. The "bleeding face" was a tooth root abscess. When the base of teeth become infected - that abscess needs somewhere to expand. Sometimes it expands right through the skin of the upper or lower jaw (more frequently upper). That's what had happened to this poor dog. I sent my technician in with an estimate to sedate the dog and do an oral exam. I also was careful to make sure he explained to her that the estimate did not cover ANY treatment and that would be additional. Silly me, not putting it in writing!

I extracted 8 of the dog's remaining 10 teeth, as they were literally falling out of the dog's head. All told - the bill was $70 more than the original quote. The owner absolutely REFUSED to pay the difference, as it wasn't quoted to her.

She even went so far as to bring her skanky boyfriend in to argue with my technician. Despite explaining to her that the dental I did cost $70 extra, whereas at a day practice, it would have cost hundreds of dollars (and RIGHTFULLY so) - she would not pay.

In the end, we were stiffed the $70. On the bright side, the little dog will feel much, much better now that the rotting teeth are gone. There was that to make me feel better about the whole stupid situation.

The next was a crazy breeder and her intact 10 year old Irish setter. This dog was not vaccinated. When asked why not, the woman replied, "I'm a breeder. I don't vaccinate." Anyway - she had brought the dog in for restlessness and panting/anxiety. She was convinced the dog had a GDV ("bloat"). It was obvious from 50 yards that the dog was not bloated, and I told the owner that. On abdominal palpation, she was severely constipated, however. I recommended xrays.

At that point, the owner told me that she wanted the "upside down" xray, not the "side to side" xray - as the upside down is the only way to diagnose bloat (according to her veterinarian - which I'm highly skeptical about). I explained how to diagnose a bloat - physical exam followed by a lateral xray ("side to side") if necessary.

It didn't matter - we did both views anyway, as we always do - lateral and VD. No bloat, just a colon full of rock hard stool.

Owner went home with dog only to call back at 3am, insisting we MISSED a bloat in her dog because we didn't do the "upside down" xray.

I'm sorry, Ms Wacky Breeder - where did YOU go to medical school?? I'm an ER doctor, for God's sake. I see a bloat a week. I know how to diagnose them! Hell, my last one didn't even need xrays, we just went to friggin' surgery. And guess what? I was right - the dog was bloated.

There were other colorful characters through the weekend...but those 2 took the cake.