One Week On Call

He looks well rested... must be his first night back on call.

Emergency work is part of what we do at Branchville Animal Hospital. We do it on a limited basis only, for several different reasons.  The on-call doctor stays plenty busy when they’ve got the phone.  How busy, you ask?  Well, it’s really unpredictable.  I have spent a full week on call without the telephone ringing (but that hasn’t happened in the last year or so).  On the flip side, I vividly remember my busiest emergency call day ever: I got 11 emergency phone calls between 7:30AM and Noon one Sunday.

The odds are that within our client base, something is bound to happen outside office hours.  I figured that I’d do one blog as a chronicle of what happens during a random week on call.  This blog is being written as the calls happen, and I’ll cover follow-up  care for those cases….. wish me luck.

Monday: My first day back on call. My associate takes the phone every other weekend- sharing coverage gives us both a chance to spend time with our families.  Just one call tonight- a depressed mastiff mix puppy that the owner suspected might have parvo.  She was correct.  Parvo, if you’re not familiar with it, is a devastating disease of puppies that is frequently fatal.  It’s a viral infection that usually kills via dehydration and secondary infection.  To treat the puppy, I placed an I.V. catheter and started antibiotics and antinausea medications.  I set the puppy up with a round of fluids dosed by a constant rate infusion pump.  The pump would ensure that the puppy would receive 50 milliliters per hour of I.V. fluids throughout the night to help prevent dehydration. If there’s an unsung hero in parvo treatment, it’s whoever invented the fluid pump.

Tuesday:  one HBC at about 6:30PM. “HBC” is veterinary shorthand for “Hit By Car”.  This dog was hit in the face and was hurting.  It had a broken jaw (it was difficult to determine the severity at this point) and what I suspected was a significantly bruised lung when I listened through my stethoscope.  We elected to stabilize for the night, get it out of pain, and deal with the jaw the next morning.  I’m cautious about diving into surgery to treat major trauma at night when I’m working solo. Trauma patients can be unstable under anesthesia. That’s the kind of thing you want to take on when there are plenty of other folks in the building to come running if you scream for help.  And yes, I’ll admit it…. I’ve had to swallow my pride and yell for help before.  It doesn’t even hurt my ego to think about it anymore.   Well, at least not as much as it used to.

Wednesday: Once the clinic opened, we started sorting out the jaw damage from the HBC incident.  We sedated the dog for X-rays and further diagnosis.  At BAH, we have the ability to wire jaw fractures back together if the fracture occurs in about the first 2/3 of the length of the jaw.  If the fracture is further back than that, then it gets beyond our expertise and surgical equipment and we refer out to a specialist. Well, this dog had it all: 2 fractures in the front of the jaw, and one fracture so far back that I knew better than to go after it.  Did you know that Birmingham has one of only 19 certified veterinary dental specialists in the nation?  We referred the case to him with an appointment made for Thursday.

On a different note, the parvo puppy from Monday started to turn the corner on Wednesday.  I was getting a little more optimistic about his chances.  No after hours calls, but I still had to go back to the clinic late that night to check on this little guy.

Thursday: one call. The case was disturbing enough that I feel that it might be better not to write about it.  Some things are best forgotten.

On the upside, Monday’s parvo case was looking a lot better, and Tuesday’s HBC dog got its jaw fixed by the specialist.

Friday: Cat fight with eye injuries:  An owner came home to find that their cat had returned from some sort of misadventure with a swollen eye. The eye looked pretty odd on physical exam, because the membranes around the eye were so enlarged that the eyeball itself was completely covered by puffy, pink tissue.  I could tell that it hadn’t been that way for long. I sedated the cat and found that some of the membranes were actually stuck to an abrasion on the eyeball.  I separated that, checked the eye again, and treated it with a painkiller and antibiotics.  Although it may sound odd, it is actually a very common type of injury.

The parvo puppy from Monday was doing well enough to go home Friday as well, feeling much better. Score one for the fluid pump.

Saturday: A good day.  We heard from Tuesday’s HBC dog, and it was back at home after being treated by the specialist. The cat with the eye injury went home looking better.  The cat’s owner even brought me a chicken biscuit for (second) breakfast as a thank you for seeing him the night before.  She had no idea how grateful I was for this.  We hosted a tour and Q+A session with a local Girl Scout troop just after we closed for business so there was no time for lunch in between.  The biscuit came in handy.  As an added bonus, the Girl Scouts gave me Thin Mint cookies (my favorite) as a thank-you for the tour, so I ate well.  Thanks, everybody!

Saturday night, I got a call from a family that was pet sitting a dog with a long-term illness.  The dog was not doing well. She had been diagnosed with cancer several months ago, but has had more than adequate quality of life up until now.  Things were changing now.  During the day, she had started having seizures, indicating that the tumor had likely reached the brain. I talked to the petsitter, but stopped short of taking any action until I could talk to the owner. The owners called me a few minutes later and we discussed what they wanted us to do.  They were coming back into town in less than 24 hours, and they really wanted to see their pet again before they had to say goodbye.  I understood.  The dog had been their companion for more than a decade. We settled on giving her a medication to eliminate any pain she was feeling and to stop the seizures.  I hoped we could buy enough time to get them back into town to see her one last time.

Sunday: I started off the morning following up with a case from Saturday.  I had run bloodwork on a sick dog during regular business hours on Saturday; the results were back from the lab Sunday morning.  The kidney values were worse than I expected.  I called the owner at about 8 AM, and things had not gone well overnight at home.  We brought that pet in for treatment early Sunday afternoon.  I also took a call to arrange for the cremation of an elderly cat that had passed away peacefully during the night.  While I was at the clinic handling bloodwork and the cremation request, another family made the decision to let a pet go that was suffering from rapidly progressive heart disease.

Mid-afternoon, I got a call from a lady who had taken over care for a VERY elderly dog after his owner had passed away.  He was having a rough time and had become dehydrated, had some vomiting troubles, and would not eat or drink. I could see that he had lost a significant amount of weight since I last saw him.  He was running a fever of 104, which explained a lot. We gave him a fever reducer and half a liter of fluids.  We talked about antibiotics and decided to give him some time to see what happens.  Given some other recent developments with him, it seems likely that he may have cancer. At his age, cancer is a tough diagnosis.  If we do wind up losing him, I will say this: he has had a long life, and a good one.

So there it is, one week on call at Branchville Animal Hospital. Emergency work isn’t the most cheerful part of what we do- if anybody’s calling you after the clinic closes, then something has gone wrong.  But thankfully, that’s just a small part of what veterinary medicine is to me.  Inside normal operating hours, I did routine surgeries, gave puppy shots, joked with clients, and wrestled with kittens.  There are certainly worse jobs out there to be had... I’m happy with mine. 



The Kindness of Strangers

a small part of the supplies donated

It’s been almost two months since the storms of late April that caused so much damage and loss of life in our area. Immediately after the storms passed, there were a group of people that stepped up to the plate and helped out local pets and their owners in different ways. Their kindness deserves some recognition, and I’d like to thank them publicly in this blog.

Right after the storms, we got busy fast. We took in a lot of boarders from storm-damaged homes and a few animals that had become injured by falling trees and flying objects. It was clients, not us, who came up with the idea of collecting supplies to send to harder-hit areas.  Good hearted people saw a way to contribute, and they made a difference. We had a few people come in within a day or two of the storm, but when we put a notice about being a collection point on the sign outside the clinic, the rate of donations really picked up.

The first things to come in were the basics- lots of food, cat litter, some water- all the things you would expect. Before it was over, I would guess that we took in about a thousand pounds of pet food. We also got a significant amount of treats, toys, carriers, and other sundry items as well.  We sent it to a few different places. The majority of what was donated went to the Shoal Creek area via the Animal Shelter of Pell City and St. Clair County Animal Control. Some of the supplies went to Pleasant Grove via a buddy of mine who was doing work there at a distribution center.

Other clients knew that there would be needs outside the norm, and wanted to find a way to supply those as well. They asked if we would accept cash to help any animals that needed it. We established a benevolence fund with the money.

The very next day, a sick dog came in from the Shoal Creek area. He needed care, and his owner was trying to get back on his feet- his house had been destroyed, and he had been able to salvage very little. The money donated to the benevolence fund made it possible to get treatment underway for the medical issues the pup had and the surgery he needed. Serendipity is a wonderful thing- the solution arrived at the clinic before the problem did.

So, to everybody who made a contribution- Thank you, on behalf of everyone helped out by what you gave. You made some dark days a little bit brighter.

-RAB

Scully, the World's Greatest Dog

Scully, April 2011

Scully was one of the first dogs we ever saw after we opened, back in 2005.

My professors in school would have described her as an Alabama Red Dog… her parentage would best be described as “undeterminable”, but that didn’t matter much. She was laid-back and sociable. We liked her because she was easy to work with, and she was a great companion. After a few visits, she usually pulled her owner, Mr. Pete, through the door so she could check out what was going on in the lobby when they arrived.

She had a fairly normal medical history for a long time- ear infections, skin allergies, and the little things that happen from time to time when you’re a dog.

In 2007, things began to get unusual for her. She came to the clinic one day with profound pain in her pelvis and legs. She wasn’t the only one hurting. You could see it in Mr. Pete’s eyes- he was upset to see her in pain.

We spent the next few weeks trying, with better success on some days than others, to control her symptoms. We took an X-ray of her lower back and found that she had some disc spaces that were abnormal. Due to extra bone formation between her last vertebra and her pelvis, a condition called lubosacral stenosis was high on the list of probable causes for her trouble. The hallmark sign of this disease is simply pain in the hips and legs, and Scully had it in spades. As the abnormal bone growth progresses, the space left for the spinal nerves to occupy shrinks. This puts pressure on the nerves that can gradually increase over time.

We spent the next two years fighting bouts of pain periodically, with Mr. Pete as her advocate, trying different combinations of medications to allow her to live a comfortable life. I’m happy to say that over time, her symptoms have subsided to a great degree. I won’t tell you that I know for sure why that is, but I would guess that the disease stopped progressing and her body compensated for the problem. She needed less medication as the years went by, and she needed our help less frequently.

Last year, we got a phone call that we weren’t expecting. Mr. Pete, Scully’s best friend and the person who made sure she didn’t hurt, had passed away. I still remember reading his obituary in the local paper. It listed his survivors as his wife and daughter, as well as "the world’s greatest dog, Scully”.

From that day on, Mr. Pete’s daughter took over Scully’s care. Scully continued on the same path as before with only occasional problems until August of last year. Scully's Mom scheduled an appointment for us to check out some lumps that had appeared. We didn’t think much of it at the time; Scully was hitting middle age and lumps are a fairly normal thing. What we found when she got to the clinic made my heart sink. Every lymph node in her body was several times the size it should have been. There are very few diseases that can do that to a dog. I talked to Scully’s Mom about sending off some samples to a lab to find out what it was, hoping that I was wrong about what I believed it was going to be. We collected samples from several of the swollen nodes, and sent Scully home with a promise to call as soon as we got the results back. I went to my office to do my medical notes for the day. When I pulled up her file, I typed this into her chart and hung my head:

8-6-10: Enlarged lymph nodes full-body, sent off samples for cytology. Suspect lymphoma.

-RAB

When the biopsy came back a few days later, it confirmed lymphoma.

Lymphoma is one of the few types of cancer that I consider to be treatable in the general practice environment that most veterinarians, including myself, work in. Scully’s family elected to try chemotherapy, and I was glad. We’ve been through two rounds of chemotherapy with her so far, and are into a maintenance phase at the moment.

Chemo for Scully usually consists of placing an I.V. catheter and giving drugs though it, as well as giving medications by mouth. She has been a real trooper. Through most of the treatment, things have been uneventful. Early in the first round of treatment, she became severely ill and would not eat.  I was not expecting this, because I’ve never seen a dog treated for lymphoma have side effects of that nature. We had to postpone treatment for a little while, but we resumed it and she has been doing great since. She’s had no nausea or any other significant side effects since late August of last year. Her quality of life (the one thing that determines whether or not chemotherapy is worthwhile in my mind) has been excellent. If it wasn’t, we wouldn’t have continued.

Now we see Scully every few weeks for treatment. She comes into the lobby looking for treats. Every time she finishes the I.V. portion of her meds, we open a fresh can of dog food. She sits on the table waiting for us to toss a piece into the air and she snaps it up when it comes close. Here’s a picture of her in action:

This picture shows the hallmarks of true excellence in tossed food catching.

In the picture, only the head is blurred by motion. The lower body is stock still, providing the solid platform a professional food catcher needs to perform at their best. Note the blurred area right next to her mouth- it’s canned food in flight. For those of you keeping score at home, Scully’s current record for consecutive catches stands at 7.

In the spirit of full disclosure, we don't know what the future holds for Scully.  Her cancer could stop responding to medication, or she could go into remission. For now, things are good- she's having no side effects from treatment. She feels just as good as she did before she developed cancer. We'll keep giving her treats as long as she cares to eat them. It makes her happy, and it makes us happy, too.

-RAB

Mikey Likes It! (funny things that dogs eat)

(Remember this guy from those Life cereal commercials?)

Mikey had been coming to see us for a long time. He was a little white Schnauzer with an outgoing personality and a mischievous nature. Whenever his owner left for work, Mikey’s house became a playground.

Finding inventive ways to land himself in the proverbial “doghouse” was a sport. I’ll start with a list of things that he ate that passed in the normal fashion:

• Paper clips
• Rubber bands
• Twist ties from bread bags
• Multiple lipstick cases (picture a white Schnauzer wearing red lipstick)
• Mascara brushes
• Makeup sponges
• 3 doses of heartworm preventative at the same time
• 2 doses of flea control… wrapper, tube and all

The number of items inside the house that he simply demolished would have landed him in jail for Felony Destruction of Property in all 50 states: the electric cord for the TV, doorstops, curtains, clothing, etc..  Nothing was off limits once the Better Angels of his Nature went off duty.

And through it all, his owner never disciplined him or fretted about the damage to her things in any way.  She loved him unconditionally.

One day, Mikey’s Mom came home from work and he didn’t come to the door to meet her.  She started searching through her house and found that he had been up his usual tricks in the kitchen, but this time he ate something that was a real problem. The owner found a half-eaten bottle of diet pills on the floor. This was about 10 years ago when stimulant heavy diet pills were more readily available.  Mikey had eaten an unknown number of these pills, and he only weighed about 15 lbs.

The owner called in from her car on the way to the clinic and told me what had happened, and that he was in bad shape. I was afraid to ask what that meant. I just told her to drive safe.

When she arrived, I was expecting to see Mikey demonstrate the kind of symptoms that stimulant poisoned dogs usually show- shaking, seizures, hyperexcitability, hypersensitivity to noise, etc. What I found when Mikey came in was that he was nearly in a coma… the exact opposite of what I expected.

He was laying on his side, unable to rise, pupils dilated, breathing very shallow and rapid, and his tongue was a sickly shade of blue. Again, very different from a textbook case. While I was checking him out, his owner told me that she had found signs that he had been vomiting, tearing up her carpet, and scratching at her doors.  While he was known to be destructive, these were not the normal things he did when she was out of the house. She had found him laying near-lifeless in her bathtub.

I started to wonder if I was on the wrong track. Maybe the diet pills weren’t the problem at all. Puzzled, I finished up the physical by listening to his heart, and then things began to make sense.

His heart rate was well above 240 beats per minute, and the rhythm was off. Arrhythmias are a common finding in stimulant poisoning cases.  As for the rest of the physical, I could only figure that he had gotten into the pills early in the morning.  I wondered what his day must have been like after the stimulants took effect... maybe running a 10K in laps around the couch, training for the Ironman Triathlon (which would explain his presence in the bathtub), and recreating Jennifer Beals’ Flashdance training routine. In my mind, he was wearing a headband and leg warmers with “What a Feeling” playing in the background.

By the time he got to us, Mikey was simply exhausted.

We put an IV catheter in him and started running fluids and lidocaine. The lidocaine got his heart into a better rhythm, and his tongue started to turn pink again. Overnight, we gave him more fluids and a mild sedative. By the next morning, he was bouncing around his cage in the treatment area, ready to take on the world again.

We called Mikey’s owner, and she came to pick him up… with a brand new crate that was going to be his home while Mom was out of the house.  In the end, Mikey wound up locked up- but not because of property destruction. Due to his delinquency, he became a Ward of the Crate.

-RAB

Do Not Open This Door, No Matter What Happens....

 (LOLcat, courtesy of http://icanhascheezburger.com/)

Handling animals is a skill learned over time. I’ve got plenty of old scars to prove it. 

Cats, when perturbed, can be the most difficult to get a handle on. I’ve got a couple of examples: 

I was working at my first job in a clinic when I was a kid, about 14 or 15 years old, in the not-so-bustling metropolis of Coldwater, Alabama. If you don’t know where that is, it’s right next to an even less bustling metropolis called Eastaboga, Alabama, which is my hometown. 

Every summer, the vet I worked for conducted a mobile rabies vaccine clinic. The vet arranged a time to be at a place (like a school or park), and people drove out to meet him there and get a rabies vaccination for their pet. My job, as his assistant, was to do two things: draw up piles of vaccines on the drive between stops, and hold animals while they were injected by the vet. The difficult part of it was that we were outdoors. There were no walls to contain an animal that slipped the owner’s leash or bolted out of a carrier. They were just gone, unless we got lucky enough to catch them.  

That particular day was a beautiful day to be working outside. Fresh air, no telephones, and bright sunshine. Nothing could be better. 

We had worked our way through a couple dozen dogs and cats when a very nice older couple walked up and asked if we could vaccinate their cat last, because it was extremely afraid of dogs. Sure thing.  After everybody else was gone, they dragged a terrified black and white tomcat out from under the seat of their Cadillac. I asked the owners if I could hold him while we gave the shot, and they were more than happy to hand him over. I was holding him at about hip level (we didn’t have a table to work on) as the vet gave the injection. I heard two things next. One was the click of the cover going back onto the needle as my boss capped it, and the other was my boss saying “Oh no…” 

I turned, thinking that he had stuck himself. Wrong. As I looked down, I saw that a stray dog had walked up on the scene to investigate the cat I was holding.

The stray looked up at me and saw the cat in my arms. His ears perked up, and you could see the thousands of years of cat-versus-dog animal instinct take control. He took a step forward. "WOOF!"

That was all it took to change the cat I was holding into a chainsaw.  The fear-fueled feline dug in his claws and spun on my hip, then clawed with all its might around my waist and up my back to get away from the dog. The vet was doing his best to frighten off the stray, and the cat was doing his best to get on top of the tallest object around.

Unfortunately, that object was my head.

I still had a grip on the cat, despite the fact that it was trying to remove my right ear. My boss was yelling at me by this point: “Let it go, son! Let it go!”. 

I have to level with you: I’m pretty sure that I couldn’t have let go of the cat if I had tried. Instead, I staggered toward the Cadillac and (ahem) asked the couple to open it up. For some reason, they didn’t open the door- they opened the trunk. That was fine by me; I was in no position to be selective. I bent over into the trunk and peeled the cat off, flinging it inside. I reached up and slammed the trunk lid shut just before the cat could turn around and escape.  

Then I saw my bloody handprint on the Cadillac trunk.  I was bleeding badly enough from the various wounds that my boss put a towel under me on the truck seat to keep me from bleeding on his seat covers on the ride home. As teenagers are bound to do (so that they can tell the story on the internet 20 years later), I went home and counted the wounds with the help of my mom. She could see behind my ear and the back of my head, and I couldn’t. The tally was 72 punctures from toenails and teeth, and 36 claw marks. Yeah, I was on antibiotics for a little while. 

A more recent event: 

The other day, a feral cat was brought in for me to neuter as part of a Humane Society program. Standard procedure when these guys come in is to check to see whether they are boys or girls before anesthesia. Apparently, this cat found that objectionable because he slashed my hand and ran out of the cage in a blink.  He headed directly for my open office door (the same one that used to have the Justin Bieber poster on it, from an earlier blog...).

I shut the door behind him, knowing that he was bottled up and couldn’t escape. I grabbed a leash and went inside, telling the rest of the staff not to open the door no matter what. They were more than happy to do just that..leaving the cat and I to battle it out. 

My office is not usually a tidy place, to say the least, but it’s amazing what a 5-minute cat rodeo can do to wreck a small space. I chased him around the office, where he showed off his Tony Hawk-like moves: frantically clawing his way up bare walls, then doing a 180 and waiting for gravity to return him to Earth so that he could do the same on the opposite wall. He ran across bookshelves. He turned over the computer monitor and wrecked potted plants. He basically knocked any object that was on a shelf onto the floor, then scrambled them all as he came through that area again on his many successive victory laps of the room. 

Eventually, I captured him when he tried to hide behind a stack of post-it notes. From my perspective, the entire affair was a lot like the proverbial knife fight in a phone booth. It must have sounded that way to the three staffers who waited outside my office in the treatment area, if the looks on their faces when I came out were an indication.

I don’t take it personally when a cat wrecks things, because that’s what cats do. However, the destruction in this incident was epic. Want proof? You can ask the staff what my office looked like (they’d love to tell you), or you can look at this picture of the aftermath taken by my wife:  

Despite his formidable escape efforts, the cat was captured and had surgery later that day.  My office also ended up getting the cleaning that it needed. And I didn't even have to go on antibiotics this time.

-RAB 

M.I.P. (vet school, dairy cows, & Justin Bieber- together at last)

Always be on the lookout for a wolf in cow’s clothing.  This is what they look like right before they attack. (photo courtesy of travelblog.org)

When I write these blogs, I often think back to vet school often because I really enjoyed my time there. The last two years of vet school are undoubtedly the best, mainly because of the variety of experiences you have. In those two years, vet students rotate through different clinics and specialties such as Surgery, Small Animal Medicine, Large Animal Ambulatory, and Equine Medicine & Surgery.  You’re doing practical work. You’re fixing things.  You’re solving puzzles. Instead of sitting in a classroom or behind a microscope, you’ve got your hands on animals. 

The “hands on animals” part is where the unpredictability lies, and nowhere is this more evident than in the Large Animal rotations.  During this time, you spend a significant part of your day working on horses, cattle, sheep, llamas, goats, or whatever else may come along. You’re outside in the barns listening to your instructors talk you through milking cows, suturing up horses with barbed wire cuts, telling you how to avoid having the llamas spit on you, etc. 

But above all, you’re listening to them tell you how not to get “Mocked”. 

A “Mocking” was the most dreaded thing that could happen to you on large animal rotations. It meant that you had been totally outsmarted by an animal and were being made to look like a fool. What made this even worse is that every clinician wore a radio, and whenever a student (or, for that matter, an entire group of students on a rotation) was getting Mocked, a radio call went out summoning all of the other students to the area where the drama was taking place. 

The radio code for this was “M.I.P.”- Mocking In Progress.  Being the object of an M.I.P. was undesirable, but being called to witness somebody else’s M.I.P. was the highlight of the week. 

One Fall afternoon, I was on equine rotation watching a subtly lame horse run to and fro between barns as I desperately tried to figure out where the problem was. There are a lot of reasons that I don’t work on horses. One of the biggest is that equine lameness has always baffled me. When a person who is good with horses tells me where the leg problem is, I figure that there are three possibilities:

 1) they’re really good,

 2) they could be making it up, or 

 3) they might have magical powers.

Just when I was about to have to swallow my pride and tell my rotation mates that I could only tell that the limp was in one of the front legs, I heard our professor’s radio come to life.

“M.I.P at the dairy barn! M.I.P. at the dairy barn!” 

I had been rescued.  All instruction, learning, and productive activity stopped immediately, and the whole group migrated over to the milking parlor to see what was up. 

A circle of people had already gathered to see the spectacle. In the middle of the circle was an angry Jersey cow that had doubled back on the students trying to herd her into the parlor to be milked. She was trying to make a break for it and get back into the open pasture when she was intercepted by two of the students assigned to dairy rotation. They were trying to turn her around and get her into the barn. She was having none of it. 

When a cornered cow is angry, several things usually happen. When we arrived, she was spinning around wildly in circles looking for a way to evade the students trying to interfere with her escape plan.  While spinning, she was bellowing a low, drawn-out, loud moo. She was slinging snot and spit and manure in wide arcs around her as she turned, like a lawn sprinkler filled with… well… the kind of things cows are typically filled with. The cascade was soaking bystanders and students who ventured too close to the whirling beast. 

Eventually, the two saturated and frustrated students literally pushed the cow in the direction they wanted her to go (as dairy cattle go, Jerseys are small). Half a minute later, she had her head in a feed bucket and was eating away as if nothing had ever happened. With the standoff over, the people and cow involved got a standing ovation from the assembled crowd, then it was back to business as usual. We went back over to the equine barns. There was a lame horse waiting for me there, and I hadn’t figured out the puzzle yet. 

That was about 12 years ago, but the memory of a Mocking stays with you. In practice here in Odenville, other kinds of Mockings happen occasionally. This one was pretty good, so I figured I’d take a picture and share it with all of you. I had been gone for a couple of days during the holidays and came back into town to find this: 
In my absence, one of the BAH crew had turned my office door into an homage to Justin Bieber. We’ve had a lot of fun with it. We still occasionally add new images to it, but like all good things, it must eventually come to an end. I figured that I’d share it before the magic is gone… 
 
-RAB 
 

Wide Open!

We are fortunate to have a guest blogger for this post, Dr. Wendy Fraser.  Dr. Fraser is currently out on maternity leave but left us this blog to enjoy in her absence.  Congrats again to Dr. Fraser and her family on their new baby girl!

I am a huge television fan.  It is truly one of my guilty pleasures.  After the kids are finally in bed I like to sit down, relax and let my mind focus on the intriguing plots of Mentalist, House, Criminal Minds and the like.  My selections are admittedly intellectual junk food.  Why do I like these shows so much?  I like them because in one short hour a mystery is solved.  There is always a rewarding answer at the end of an hour, everything is neatly wrapped up and everyone is satisfied.  That rarely seems to happen in real life, particularly in veterinary medicine.  I like the fantasy that everything has an answer and if that answer can be found in under an hour so much the better. 

Real life is much more frustrating.  For example, one Tuesday morning when working at another clinic in the Birmingham area, an owner called about a sick German Shepherd.  The owners were concerned because the dog would not come out of the dog house.  The receptionist recommended that the owners bring the dog in for an exam.  We went about the usual workday until late afternoon when the receptionist said, “I think that sick dog that wouldn’t get out of the dog house is here.”   There were no clients in the lobby so I was curious as to how she knew that that particular dog was here.  When I walked up to the front lobby and looked out the window I knew how she knew:  a truck had pulled into the parking lot and on the back of the truck was a HUGE doghouse.

The driver of the truck and his companion had begun to unload the dog house and carry it into the clinic.  The dog that wouldn’t get out of the doghouse was now in the lobby, doghouse and all.

I started to take a medical history from the owners.

How long had the dog been in the dog house?  Two days.

Has he eaten anything?  No. 

Does the dog ever run loose?  Sometimes. 

Inside the dog house was a 70lb, 3 year old German Shepherd lying on his side, his eyes were unfocused but he was breathing steadily.  To the side of the dog were some scrambled eggs and there were two pieces of toast on top of the dog.   I took the top off of the dog house, dusted off the eggs and toast and moved the dog to an exam table.   At first, the dog appeared to be in great health.  He was a healthy weight, had no skin lesions, was staring straight ahead and breathing deeply.   All the vital signs appeared normal.  What do I know about the dog at this point?  He was young, was healthy three days ago, doesn’t have an appetite for eggs and toast, and is in a coma.  That was all the information I could gather and when presented with a case such as this you have to consider all factors, even beyond what the owners tell you (for any other TV junkies out there, think… House.)  These owners would like to do whatever they can to help the dog.

At this point, my diagnosis of the dog is open, WIDE OPEN.  This means that I have no idea what is wrong with this dog!  Typically in a case like this Dr. Bean, Dr. Compton and I put our heads together and come up with what is called a differential list of possible causes and try to pick diagnostic tests that will help to rule in or out any of the illnesses on the differential list. That’s exactly what I started to do.  The most likely causes in this case were trauma or toxins because the dog wasn’t skinny or sickly looking, indicating that it had not been ill for long.  He looked great and was in fact a beautiful dog.   

It had been almost an hour since he arrived at the clinic and I was still not close to solving this one.  Unlike on those medical dramas on TV, dozens of assistants had not appeared to take samples and whisk my patient away for tests.   I drew blood samples to send to the lab and treat for dehydration, infection and inflammation.  My only options now were to wait until the next day for his blood work results and monitor him for responses to my treatments.

The blood work results from the next day were normal.  We tried every reasonable course of treatment but nothing that I did seems to change the dog’s condition.   After 3 days the owners elected to euthanize him.  Many, many hours were spent thinking about this dog and there was no satisfying answer at the end.  All that we have are unanswered questions, frustration and sadness.

So, how do I cope with cases like this?  I go home, put the kids to bed and watch an hour of junk!