Some fun pictures, because the rest of this post is weird.
The carpet of flower petals from our tree
Sushi from the local amazing sushi restaurant inventively named Sushi King (so good though)
I have successfully transferred to Germantown. I'm really happy there. However, I have become a magnet for weird cases.
In the last 10 days, I have had the following cases:
- 6 month old, stunted growth, super laid back puppy with seizures. Bloodwork normal. Liver is normal. Has two grand mal seizures in the space of four hours in the clinic during liver testing. Only other differentials outside of a portosystemic shunt are 1) epilepsy 2) f'ed up CNS
- 3 year old seizing, pacing, dying patient diagnosed with a portosystemic shunt. Owner calls me at 6am says I have to come into the clinic RIGHT NOW HE'S DYING. I live 30 min away, clinic isn't even open until 9am. Owners refuse referral. Drive there, euthanize, have to buy work clothes at Target because still in PJs.
- This cat came in for Polyphagia (eating too much). Do rads. See staples in the colon. OMG we all freak out, this cat needs an exploratory. Show clients. Oh, yeah, he had surgery for megacolon a few years ago, they used titanium staples during the surgery.
- Older dog with a lot of problems (KCS, hypothyroidism, arthritis) isn't acting right. Rads show a mass effect in the abdomen. Spleen feels massive. Tentatively tell owners that it's hemangiosarc, recommend referral or euthanasia. Owners opt for euthanasia.
- 1 year old dog, in for a dental cleaning. Routine bloodwork shows increased creatinine and BUN (which indicates renal insufficiency) call owner, freak owner out that her 1 year dog is dying. Dog is also wildly PU/PD (polyuric/polydipsic, aka drinks a ton, pees a ton) at home. Do a CR:Protein ratio. It's normal. No idea what's wrong with this dog.
- 12 year old cat is PU/PD, peeing everywhere. Weird mass on abdominal palpation. Cat is not spayed, suspect pyometra (life threatening uterine infection). Spay the cat- has huge ovarian tumor. Successfully remove tumor.
-Been seeing a 16 year old beagle for long term arthritis/heart failure/kidney failure. Owners call, say he's not doing good ask if they should bring him in. Say come in after lunch. They show up during lunch break, dog in their arms, they're hysterical "HE'S DYING, HE'S DYING". Heroically sweep dog out of their arms, run to back, get dog on oxygen and get vitals. Blood pressure is sky high, dog is recumbent and moaning in pain, breathing is agonal. Have owners come to back to talk about options. "We can't do this anymore, we can't do this anymore!". Okay, we're euthanizing. Want to make it quick, so grab a butterfly catheter :
It looks like that. A butterfly is very different from a regular catheter. This is a regular catheter
A regular catheter is inserted into the vein and taped into place. It takes a while to do. I was in a hurry. I get the butterfly, try and stick the front leg veins. I fail. The owners are watching and the dog is moaning. The techs are looking at me like "WTF are you doing?" but we're all trying to pretend this is normal. I stick a back leg, get flash, start injecting euthasol. The vein blows. "CRAP CRAPCRAP" I think. Even got in that the dog is at least asleep. Pull up another 5cc, stick the other front leg, get flash. Start injecting, it's not blowing. "YES, I DID IT". The syringe explodes off the line, euthasol goes everywhere. "M-FER" I think. The techs are giving me crazy eyes, the owners are still there. Pull up another 5cc, start injecting, it goes in. It's over. Put the dog in the freezer. Client back the next day. They want to see the body, for closure. Spend 30 min with dog's frozen body. Ask for a hair sample, cut them some hair. "Is this enough?" I ask "I can cut more if you want". "No, no this is enough". Tomorrow they call. "We need more hair". I open the freezer, tear open the body bag, and shave this frozen dog all over, get a bag full of hair. "This better be enough gosh-darn flippin' hair!"
- Client runs in at lunch. MY DOG ATE RAT POISON! Techs are holding dog. GIVE THAT DOG HYDROGEN PEROXIDE NOW, NOW NOW! Give that dog 100cc of H2O2! Dog vomits and vomits and vomits. Green rat bait all in it. Feel pretty good about myself. Ask client what type of rat poison it was. He shows me the box. Uh-oh. It's bromethalin. The sudden-seizing-death kind of rat poison, not the vitamin K type of rat poison. Crapcrapcrap. Other doctors freak out. Grab 100cc of activated charcoal, start pouring it down that dog's throat. Tell owner that it could be touch and go, he could suddenly die. Owner is distraught. Have the dog come in for two days of IV fluids and charcoal; the dog lives.
- And the coup de grace, my IMHA dog from yesterday. I don't think people get this, as the parents didn't know what it was and all the websites for it feature dogs. IMHA is when your immune system decides your red blood cells are bad, and sets out to destroy them. ALL OF THEM. RBCs are necessary to life. This is not a good thing. The chances of survival are 50/50 AT A REFERRAL FACILITY with an ICU and 24 hour top of the line care. The main risk is the dog throwing a clot and dying suddenly and horribly of a pulmonary thromboembolism. It can happen at any time. This dog also has a long history of urinary stones, so much so that her bladder on palpation feels like a bean bag. The dog has never had surgery for this condition because they can't afford it. So the dog comes in yesterday for peeing blood and not acting right. Go out, talk about urinary issues, blah, blah, blah. Decide to do an ultrasound, take her in the back to shave her and OMG SHE'S YELLOW. Her skin is yellow, her ears are yellow, her gums are yellow, and her sclera is yellow. Tell the owners that this is SERIOUS, we need to act NOW. Bloodwork is jacked. Her hematocrit is 13, it should be 40. Her white count is sky high, she is anemic as all get out, her bilirubin is at 8 which is 10x the normal range, her liver enzymes are whacked and so is her BUN. Tell clients they must go to referral. Referral would cost $1000 (at the absolute cheapest) to $5000. Clients can't do it. I say we can try to save her for $500-$700 here, if they can't do that they must euthanize. Clients say they will try with us. Take dog to back, doctor huddle ensues. None of us have dealt with an IMHA since vet school and the guidance of an internal medicine specialist. We pull out the books. This dog needs a blood transfusion, an oxygen cage, and potassium supplementation. We don't have that stuff.
We do fluids, IV antibiotics, and IV steroids. She's still alive, just hoping we get a Christmas miracle in May and she lives.
