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.