Nothing veterinary related

My best friend from vet school and her (new) fiance are visiting for the weekend. We spent Saturday and Sunday at my uncle's cabin in Morganton, NC. It was a stunning weekend in western NC. We spent some of the first day touring the area in the Mule, as I showed my friends around my uncle's property. Dinner was prepared by the fiance, and he is a gifted chef (he used to work as one professionally). I have rarely had food such as he made (filet mignon with brandy mushroom sauce, asparagus, and purple potatoes). We rounded out the night by watching the stars for a few hours (no light pollution in the middle of nowhere) and then with Top Gun on the projector screen.

The temperature today was in the mid-70s, and the humidity was very low. It was absolutely gorgeous. We hiked up Table Rock today (visible from my uncle's land) and got a breathtaking view of the Linville Gorge and the Amphitheater (much of where The Last of the Mohicans was filmed). It was a great 2 mile hike, and Heidi did wonderfully. We also drove onto the Blue Ridge Parkway and hiked along the road a bit to savor the panoramic view of the Smoky Mountains. How I miss home! How I miss the mountains! I once read about a famous photographer that said that the Smoky Mountains are the hardest to photograph. After attempting to do so myself several times, I agree. Nothing captures that absolute silence and vastness of some of the views along the Blue Ridge Parkway. They are dizzyingly gorgeous. If you've never visited, it is a definite must-see.

We're home again and tired...they leave tomorrow, and it's back to work for me. I'm worn out! My parents have been here, my best friend, I'm bottle raising 3 kittens, one of which is doing poorly and needs subcutaneous fluids and occasional dextrose...I don't feel like I've caught up on my sleep at all. Alas, I probably should do so before Wednesday!

(P.S. - That picture of the grey rectangle with greenery in the center is through an aqueduct hole in the Blue Ridge Parkway. You can see straight down for about 50 feet. My whole foot could fit in that hole. Made me kinda nauseous but made for a great picture!)

(Oh and P.S.S. - Doesn't Heidi look wonderful? She's been running with my husband, and we try to take her wherever we go that she can be outside running. She's building up muscle and has gained weight, up from 55# to 68#!)

Miscommunication

We had a terrible mis-communication with an owner recently. She brought in her 3 year old mixed breed dog, Marti. Marti was exhibiting severe neurological signs - a head turn to the left, cervical neck pain, occasional seizure activity (per the owner, we never saw the seizures), and mild mental stupor.

Our differentials were meningitis/encephalitis of some sort - possibly GME or NME, or something like West Nile virus.

The referring veterinarian tried as hard as she could to get the owner to take Marti to a neurologist for diagnostics and treatment. The owner declined. As a result, we wound up admitting the dog one night last week to our hospital.

The treatment for NME is steroids, which we started Marti on. Her condition deteriorated over the next couple of days, but the owner still refused to take Marti to a neurologist. I took over the case on the dog's second night in the hospital.

When Marti transferred back, she was lethargic, poorly responsive, and weak. She could not lift her head. I again begged the owner to seek a neurologist's opinion. It was at about that time that my technician paged me to the ICU. I was confronted with this:





That, my dear readers, is what REAL bloody vomit looks like.

Back I went to the room. I looked at Marti's owner, a young, intelligent, well-spoken women and asked, "had you been giving anything at home prior to when we first saw Marti?" She nodded. "Baby aspirin," was her reply.

My stomach turned. "But I told the other veterinarian," she said. "At least, I thought I did. Maybe I only told her that we gave aspirin LAST time this happened." (The first episode had been about a month previously).

What happened to Marti is that she received aspirin, a non-steroidal anti-inflammatory medication (NSAID), as well as a steroid. These drugs work on the same inflammatory pathway, and using 2 at once can cause SEVERE, SEVERE damage to the GI tract. Why? NSAIDs AND steroids inhibit prostaglandins. These PGs are responsible for mediating inflammation and down-regulating them will help dampen the inflammatory response. PGs have good effects, too. They mediate blood flow to the kidneys and function in acid secretion in the stomach. When you suppress them with NSAIDs and steroids, you lose the good AND the bad. This is usually not a problem unless you 1) take massive dose of NSAIDs or 2) you MIX steroids and NSAIDs. Even though we were using a tiny dose of steroids, it was enough to cause a horrible, bleeding ulcer.

The owner finally consisted to transfer Marti to a specialist (after seeing the vomit firsthand). By the time Marti arrived at the local specialty clinic, her PCV (measure of red blood cell mass) had dropped from 46% to 32%, indicating internal bleeding. This was occurring into her stomach from her bleeding GI ulcer. After much discussion, Marti's owner elected to euthanize her.

It was a terrible, terrible thing and an important, potent reminder of why we - as veterinarians - should always, always, always ask, "Have you administered any medications to your pet lately - EITHER prescribed OR over the counter?" And that's why you, as pet owners, should always, always, always tell your veterinarian if you have given something to your pet.

My dad

In not crazy news

Great week ahead...

My parents coming today for a 3 day visit - SO EXCITED.

My best friend from vet school and her boyfriend coming on Friday for the weekend.

Oh, and 3 new bottle kittens. Ha. All 3 from different litters and arrived at different times over the last 2 weeks. I have a problem.

OMG ...the crazy.

Saturday night, we were sitting on our collective fannies...when the door burst open. A young woman staggered - and I mean staggered - into the ICU carrying a limp dog.

"Heyyyyyyy," she slurred, "I gotta unconscious dog."

We took the dog from her, and my tech herded her into the waiting room.

The dog was not unconscious. It was dead. She had BEEN dead for about 2-3 hours, as she was in full rigor mortis. I could feel the heat baking off of her body. Rectal temperature was too high to read (>108). She had bruising all over her gums, ears, and skin. She was fairly classic for a heat stroke (it had been in the high 90s all day).

The plot thickened when the actual owner showed up (girlfriend to Drunky McBrewster in the waiting room). She was sobbing uncontrollably, gasping and hiccuping for breath. When she saw her girlfriend - drunk or as stoned as a fiend - she uttered a guttural, "GET OUT." The girlfriend scuttled out the door.

Meanwhile, the owner turned to my tech and said the following, "She's messed up on drugs. She doesn't know what's going on. I came home from work and found the house trashed, blood everywhere, and Betsy (the dead dog) in the TRASH CAN."

It's not funny. It's not funny in any way, shape, or form, but I felt hysterical laughter bubbling up inside me. The drunk/stoned women threw the dog in the trash can! Seriously!?

I'm doing it

**Also - if you read my blog regularly, please become a follower. I know there are many lurkers out there, and I'd like to know who you are. I read your blogs too!

After yet another email from my retired English professor grandmother imploring me to follow my true calling (?? funny, I thought I was doing that), I have officially started working on my book. I've skimmed the market, found that veterinary medical books are very popular (Tell Me Where It Hurts, All Creatures Bright and Beautiful, etc) and have gleaned that there are no current books like the one I am writing. It's already coming together quite well after 5 hours of concerted effort and organizing.

Here is my question for you, my readers:

1) Would you rather read a book about veterinary medicine written as a cohesive, linear story - i.e. I got up, went to work, this happened, came home, this happened? Or would vignettes a la James Herriot with a grand, unifying theme be more interesting?

2) Would you read a book about veterinary medicine? I assume so, since you read my blog, but I'd like to know if you'd buy a book on the subject?

To clarify

For anonymous - the general layout is similar, although what is called the fallopian tube in women is called the uterine horn in dogs.