For my husband

Two for three during the wintry week

Busy, busy week back at work. I got home from NAVC on Thursday afternoon. I finally caved and took a Xanax to fly. I've only ever taken Xanax once in my life, and it was also to fly. Since then, I've been fine on planes. I knew I would be apprehensive about this flight though because of the cloudy, rainy weather. Take-off was nerve-wracking, as always, and I just assumed the tiny dose of Xanax I took didn't work (0.25mg for anyone interested). As it turns out, it must have worked some. I failed to notice that many people on the plane were vomiting due to the turbulence (pointed out to me after landing by my somewhat shaken flight companion). The turbulence itself didn't even phase me. Go figure. Oh, and the fact that our plane taxiied out to the runway, then had to taxi back to the gate for flap repair, and we were delayed over an hour didn't phase me either.
What I left:



So, I got back Thursday night, started back to work Friday night. I've worked the last 6 nights out of 7. It's been hectic. Saturday night, I had a lovely 18 month old Bull mastiff with a fluid distended stomach. I removed a rubber ball from her intestines. The next night, I had a dachshund that liked to eat acorns. I removed that from the small intestines as well. Both patients are doing great at home and I consider them successes to add to my list.

Last night was my final night, and I had another patient with acute vomiting, history of eating multiple foreign bodies, and progressively worsening gastric dilation with fluids on xrays over several hours. The radiologist said point blank, "if this was my dog, I would cut." I felt the same way. You can guess what happened...we cut...and there was nothing. We released the evil spirits and closed the dog back up. I hate, hate, hate, hate, hate doing negative exploratory surgery. Its costs the owners a lot of money, which can be stressful in this economy, it puts the animal at risk for post-operative complications (I had to open the stomach in this case to examine the contents, which turned out to be a lot of kibble, fluid, wood chips, and hair - but no obstruction), and carries the risk of anesthetic death. It's something every vet does and something most vets HATE. I am no exception. So, of course, I go back over the evidence and convince myself I should have known better...and of course, surgery could have waited...and blah blah blah.

I'm off for 4.5 days, and I need it desperately. I'm so tired right now my chest hurts. The weather is FABULOUS for staying indoors. The roads are ice/slush, there is 2-3 inches of white powder in front yard, and I don't have to do anything until Wednesday night. I'm happy. I'm one of those people that still gets giddy like a child when I see snow.

Cardinal sentinel:



Some pictures of the "beautiful" weather we're having, as well as one of the beautiful weather I just left. The bird congegration was taken through the screen porch door so as not to disturb the fluffies. At one point, there were 15+ birds in that tree including 2 female cardinals, 2 male cardinals, a blue jay, a mockingbird, a robin, and a couple I didn't recognize. Oh and a lonely chickadee.

Porch kitty demonstrating her kitty door (and delicate, feline sensibilities about getting her paws damp):

NAVC recap

The last week has been an absolute whirlwind of activity. I'm exhausted. It's been a totally different experience when compared with NAVC last year. I came alone in 2009, and while I enjoyed the family time, a conference is a rather lonely experience without friends and/or colleagues.

This year, I was joined by inarguably my 2 closest friends from vet school. Our days began at around 7am and tended to end past 11:00pm. On top of that, one of my internmates was there. We didn't get along well during my internship, but that was partly because an internship is such a hard experience. Now that it's over, I really, really enjoyed her company. Add to that this funny occurrence: I walked into my very first meeting, with over 400 vets, sat down, and realized that 3 seats down was a relief veterinarian from my current town. She pulls ER shifts for us occasionally. I always liked her a lot at work, but I've never seen her much outside of it. She joined our little posse as well (and was in the lab with me). All in all, it was a thoroughly fun, busy experience.

There were lots of great learning opportunities at the conference. I took a great wet lab (Advanced Emergency Procedures). We attended the Foreigner concert on Monday night, as well. Last night was the Sea World shindig sponsored by Schering-Plough. The whole of Sea World was rented out for us last night. The beer and wine was free, the food was free, the games were free, the 2 big coasters (Manta and Kraken) were open, as was Journey to Atlantis (flume ride). There were dolphin and sea lion shows. The finale was the Shamu show (which, while hokey and a little obnoxious due to the loud, cheesy music and video show, was still fantastic).

We slept "late" this morning (i.e. 9am) and then I took them to the airport. I have one more day here, then I too, shall head home. Speaking of home, it has not been without its excitement. My African grey and Senegal got into a big fracas. The grey was (of course!) uninjured. My Sennie wound up having to see the avian vet in our town last night (luckily, a friend AND neighbor). He spent the night at my work, but he is home today and expected to recover fine.

Did I mention how tired I am?

If you want a taste

of veterinary student perspective - head over to http://dvm2be.blogspot.com/. Hermit Thrush is a 1st year veterinary student at Cornell in Ithaca, NY. You can also read my back files, although there is a 1 year gap. I've been rather slow in reposting all of my old vet school posts. I'm getting there, I promise.

Update on : Lessons in bladder control (see bottom)

A 9 month old puppy presented to me on Sunday night around 9pm. She was down-in-the -dumps sick: dehydrated, vomiting, and passing a large amount of very, very bloody diarrhea. She looked like your typical parvo puppy. The parvo test was negative, and the white blood cell count was a whopping 60,000 (normal up to 13,000 or so). I discussed starting aggressive treatment with fluids and antibiotics to the owners (coincidentally, these are the same owners whose cockatoo I treated a month or so ago).

We started treatment, but the puppy continued to deteriorate despite aggressive fluid replacement. I palpated her abdomen again carefully, and I could swear I felt a mass that kept moving - disappearing momentarily and then coming back. After really mulling it over, I decided to call the owners back and tell them that I thought exploratory surgery was warranted. It was a hard call to make. The xrays didn't show an obvious foreign body, but they were UGLY. I had a hunch something was seriously wrong. As a sidenote: one of the things vets hate most is doing a negative exploratory (not finding anything obvious to explain the clinical signs - such as a foreign body or strangulated bowel loop). The owners, despite financial concerns, opted to go for it.

I was not quite prepared for what I found (although I should have been, as what I found is a big differential for bloody diarrhea in a puppy). The intestines were kind of a knot, and there was fibrin in the abdomen. The omentum (membrane that covers and nourishes the guts) was adhered to the big knot in the middle. I gently pulled it out and stared at it, not quite sure what I was looking at. As I teased the omentum away slowly, I finally understood. I was staring at my first GI intussusception.

That big fancy word describes when the intestines become hyper-motile and telescope in on themselves. Essentially, the large intestines try to eat the small intestines. Often, it becomes stuck that way - as this puppy's had - probably a couple of days ago. If it's a fresh intussusception, you can milk the intestines out of themselves and presto majesto finito. In this case, the problem had been present for at least 2 days. I could slide my finger into where the guts telescoped, and feces came back out. There was a hole inside. That meant only one thing: a resection and anastamosis.

I had to cut out the bad part and sew the good ends together. In the small intestines, this isn't hard - they heal great. In this case, however - I had to cut the colon/large intestine. It DOES NOT heal well. You never cut into the colon unless you have no other choice. I had none.

I cut it out, sewed it back together, debated whether it looked healthy, and finally, took a deep breath, tried not to pee on myself in fear, and closed up the dog.

Four days later, she is doing great. No more vomiting, she's eating, wagging her tail, and totally normal. The first 48-72 hours are critical, but I think we can safely say that we're out of the woods now.

That surgery was a huge rush for me. It was my first of that kind, and I was very proud of the way I handled it. 2 hours from start to finish, and my patient is doing GREAT.

Ahh! Sometimes I love my job.

Update: My patient recovered beautifully (this is an old post from September) and to this day, is growing like a weed and healthy as a horse!

Mystery and intrigue

Last Tuesday, an owner called and stated that her dog was having seizures, and she was bringing her in.

When the dog came in, the owner was cradling her in his arms, and the dog was trembling terribly. I rushed to get the Valium while my technician gathered information on the case.

The history: no seizures in the past, normal up until that night. Then the dog went outside to use the bathroom. The owners didn't accompany her to the yard, as it was raining. She was outside for a few minutes, came back inside, and started to "seizure."

The "seizuring" had contiued unabated since then. On presentation, the patient's temperature was 108 degrees. Valium did nothing to help control the "seizures." It was only after the first dose that I realized that my patient wasn't seizuring. She was having terrible, generalized muscle tremoring. The difference was obvious once I really looked at my patient. She was aware of us, attempting to look around, but she couldn't walk due to the tremoring.

I discussed with the owner that I strongly suspected a toxin of some sort. I grilled them about anything she could have gotten into ... moldy food being my biggest concern. The owners were adamant that they knew of nothing.

They went home and left the patient in my care. Over the course of the night, I couldn't get the tremoring under control. I resorted to general anesthesia with propofol (yes, the drug that killed MJ). Strongly suspecting toxin, I also pumped her stomach (gastric lavage) and then gave her activated charcoal. That's the black stuff in the drain. It coats the stomach and prevents further absorption of ingesta. What came out of the tube looked and smelled exactly like moldy food.







It was around that time that the owner called me back and confessed that her boyfriend had thrown a great deal of moldy food from their fridge into the backyard. Moldy chicken noodle soup, bread, and cheese. They also noted that when the dog came back in the house, it came from the side of the house where the moldy food had been thrown. The tremoring started 30 minutes later, consistent with mycotoxin ingestion. Mycotoxins are mold species that grow on food and can cause severe tremoring in dogs.

Unfortunately, this dog was severely affected, and the owners lacked the funds to treat for the required 2-4 days. She was euthanized later that day at her veterinarian's office.

This case offered an important lesson: what the owner perceives to be occurring and what is actually occurring are not necessarily the same thing. When the dog was presented, I heard what the owners said: seizure and treated accordingly. It was only after assessing my patient that I realized my error. I wish it had made a difference in the outcome for my patient, but sadly, it did not.