Last week I had a very unusual case. A young bearded dragon had somehow gotten its leg stuck on an artificial rock in its enclosure. In trying to free itself, it had ended up twisting its left hind leg around several times, ending up with a complete spiral in the leg. The tissues were obviously damaged beyond healing and the only choice was amputation.However, this was a very tiny patient. Its entire body was no longer than the length of my palm and it weighed only about 2 grams. I've done surgeries on exotic pets before, but never on one this small. I knew that he wouldn't survive without the surgery, but I also worried whether or not he would survive the surgery itself. On such a small patient we can't take standard precautions of using monitoring...
Waiting Too Long?
A common complaint heard in veterinary offices is the clients being bothered by how long they have to wait. Being in a room for 30 minutes is too long. Having to wait several hours to pick up their pet is too long. Waiting 15 minute for the fecal exam to be read is too long. Yet those same people are more accepting of waits for their own doctor.All of that went through my mind as I was doing my own waiting today. My son was running a fever yesterday and complaining of a painful neck. This morning my wife took him to an urgent care center to be examined (it's Sunday, so no doctors' offices are open, and we wanted to avoid the Emergency Department at the hospital). The doctor easily determined that he has strep throat, but was concerned about the fact...
Yes, It Can Happen To Vets
Today I took my dog, Inara, to work with me for her annual vaccines. She received a rabies vaccine, distemper-parvo, leptospirosis, bordetella, a fecal exam, and a heartworm test. All of the things I recommend to my clients I also do for my own pets. Inara was a trooper and handled all of it well. I did her services first thing in the morning and then put her in a kennel while I started to work on morning appointments and surgeries.Two hours later I was in the back getting a patient and decided to give Inara some attention. To my great surprise I saw that her whole face was inflamed and puffy. Yes, my own dog was having a vaccine reaction. She had received these same vaccines as a puppy, and these were her first annual boosters. When she was...
Dogs don't think like us
Humans think. We rationalize, we remember, we anticipate, we cry, we stress over our past and our future. Dogs and cats are hardwired to respond in the moment. A hungry cat will eat, a stressed-out cat will bite your head off, a territorial dog will bark or bite, a calm and submissive dog will roll onto her back and let you rub her belly.The reason for this post is simply to ensure we understand that much of what's going on in a pet's head at any moment is fleeting. To illustrate this further: just the other day, a very friendly dog that was delighted to meet me would've taken my arm off while I performed an orthopedic exam on him if it weren't...
Addendum: take 2
See previous two posts for details. The histopathology results came in on the cat on which I performed the necropsy. Shockingly, this cat had a metastatic carcinoma of the intestine. A clot was indeed found, however it was intimately associated with this intestinal tumor. The tumor likely acutely bled, leading to the formation of a clot, which led to the ischemic event (lack of oxygen) that resulted in the hemorrhagic necrosis of the intestine (see photo in previous post). The clot had absolutely nothing to do with heart disease as the heart was normal. An incidental finding was chronic pancreatitis. A specific laboratory test for feline...
Disolcated Hip
Last week I saw a dog for some vaccines. The owner happened to mention that he had been limping for a few days (often seems to work that way..."Oh, by the way, doc..."). When I was looking at him I quickly noticed that he didn't want to put any weight on this left hind leg, and some manipulation isolated the problem to his hip. I was able to put a finger of each hand on the point of the femur and noticed that my fingers were uneven. So my first thought was that somehow he had dislocated his hip. A quick set of radiographs confirmed my suspicion.Looking at the images you can see that the hip is completely out of the...
What Voice Mail?
Does anybody bother checking their voice mail anymore?Here's something that's happening with increasing frequency. I call a client to let them know that their pet is ready to be picked up. I end up getting their voice mail and proceed to leave a detailed message with any findings, treatment plans, and other information. Now, I'll only do this with routine cases, not ones where I really need to get more information or discuss something at length. But I do this in cases where I just need to pass on some quick details and don't need to speak to them directly. Then the client calls back shortly afterward...."Yes, I received a call from your office." But they don't know what the call was about. What? Obviously they simply saw the number on their caller ID and never bothered...
Dogs & Cats, Living Together...
It's a great line from one of my all-time favorite movies...Dr. Peter Venkman: Or you can accept the fact that this city is headed for a disaster of biblical proportions.Mayor: What do you mean, "biblical"?Dr. Raymond Stantz: What he means is Old Testament, Mr. Mayor, real wrath-of-God type stuff. Fire and brimstone coming down from the sky! Rivers and seas boiling!Dr. Egon Spengler: Forty years of darkness! Earthquakes, volcanoes...Winston Zeddmore: The dead rising from the grave!Dr. Peter Venkman: Human sacrifice. Dogs and cats living together. Mass hysteria!The implication is that the idea of dogs and cats living in harmony is pretty ridiculous...
Unexpected Hernia
Here's the case that kept me from getting to the dog I mentioned in yesterday's blog.A client of ours had found a little stray kitten and brought her in for the first exam and vaccines. At first glance she seemed a little dirty, but overall a sweet little four month-old kitty. We proceeded to collect blood for a feline leukemia and feline AIDS test, ear swab to check for mites, and a fecal sample. As I started my exam, things seemed okay until I listen to her chest. Very quickly I noticed something strange.Like humans, dogs and cats have hearts that are in a position slightly to the left of the midline of the body. ...
A Little Patience, Please
Sometimes I just don't understand the impatience of people.Today we had a client call us saying that her dog was sick, wasn't acting well, was dehydrated, and hadn't urinated in over a day. That sounded pretty bad, so we told her to bring her dog in. All of our appointments were booked up and we were still finishing up morning surgeries, so we told her to drop the dog off and we would look at it and call her back. My receptionist told her that it may be a few hours before the doctor could look at the dog but we would call as soon as we knew something.Between surgeries I peeked in on the dog, a shih-tzu around a year old. He was wagging his tail and barking, and certainly didn't look sick. So I finished my morning drop-offs and procedures, took lunch, and came back a...
Addendum: I did find out
The client whose cat died (discussed in the previous post) requested a necropsy (called an autopsy in human medicine) a day after the cat passed, which I performed. Dr. Vassey, who left a comment below, most likely got it right: the cat likely died from an infarct (thrombus/clot) that acutely became lodged in a blood vessel supplying the intestine. Without normal blood flow, and therefore oxygen, the intestine literally "died."The cat's entire intestine was grossly hemorrhagic and necrotic, while other abdominal organs were spared this pathology. I found a massive clot in a blood vessel feeding a portion of the intestine, which I submitted for...
Emergency
A client showed up yesterday morning with her "crashing" six year-old cat. The cat was vocalizing, in severe pain, was markedly hypotensive (low blood pressure), and had pale gums. The elderly owner lives in an apartment, where there was no possibility of having been exposed to toxins, including rat poison, and no toxic plants which the cat could have ingested. She reported that the cat had vomited a few times the day before and that the vomitus contained blood and blood clots.The cat was evidently in shock. We treated the cat for shock, provided judicious but important pain control for this poor, painful, kitty, and ran a whole slew of tests...
Taking It In The Face
I've already talked about how gross veterinary medicine can be sometimes. But what I didn't mention is where all of the fluids and other things can end up. Often, it's right in the face.Last week I was flushing out a dog's anal glands and had some of the fluid splash back into my face. A few months ago I was looking at a problem with a dog's rectum and narrowly missed being squirted in the face with explosive diarrhea. It's pretty routine to have a dog sneeze kennel cough vaccine back on us after we've given it (it's an intranasal spray). I've had arteries arc towards my face after being cut during surgery. Frankly, I'm glad that I naturally wear glasses and have some built-in eye protection. But the worst case I've ever heard of was about 11 years...
Volunteers Needed!
Richard, a veterinary student from Ross University, sends in this email.... First off, thank you for taking the time to read my email. I've been reading your blog for a while now, and not only do I enjoy seeing the practitioner's side of some issues, it is a great example of how to communicate with the public at large. I know that you encourage questions from your readers, and you may be able to help me with a little dilemma I have. I need to build a portfolio of case studies for my pharmacology class. The idea is to put together short videos of a variety of cases, before and after medical treatments, along with some basic information about the medications they received. Then I have to provide a narration discussing the method of action, pharmacokinetics, adverse effects, etc. based on...
Bragging Rights
To me client service is extremely important. In an economy like our current one it's difficult to drive business and succeed strictly on price. To truly win, you have to have excellent customer service. Though I'm far from perfect, I pride myself on creating this kind of environment in the practice I manage. And sometimes you do win.Today I had a client pay me one of the biggest compliments I've received. She was friends with another one of our regular clients who apparently has had nothing but great things to say about us. The new client had come to us specifically because of her friend's recommendation. And the greatest part is that she drove an hour and passed numerous other vets to get to us. The word of mouth was so good, that she went out...
Not Expecting The Unexpected
Today I neutered a three year-old boxer. He had recently been seen at my practice for testicular pain, with the suspicion of an inflammation or infection in or around the testicles. He responded well to antibiotics and pain medication, but on the recheck exam I noticed that the firm swelling had not resolved. Suspecting other problems, including cancer, I convinced the owner to have him neutered with the possibility of a biopsy of any suspected tissue.Normally a routine neuter takes me around 10 minutes to do. Since I was expecting some masses attached to the testicles I thought it might add an additional 10 or so minutes to the surgery time. After having been in practice for almost 13 years, I should know better than to expect things to go smoothly in cases like...
Canine Couch Potato
I have come to the conclusion that one of my dogs, Inara, is a fan of TV. However, it must be certain programs or movies. She is around a year old and is a yellow lab mix. Normally she's pretty active and loves to play, though thankfully she has calmed down a bit once she reached adulthood. Television normally doesn't interest her, and she will lay quietly on the bed or couch, chewing on one of her toys.Until a show comes on involving dogs. Right now we have Homeward Bound on TV and she has been watching it intently. Whenever the animals come on she will turn and watch it, even leaning closer to the TV. In a few scenes she has even growled a little. When scenes have only people, she will turn away and not seem to care. It's been very interesting...
A Real Mess
Anyone who thinks that veterinary medicine is glamorous has obviously never spent time working with a vet. I was just talking with some friends of Facebook about this, and I don't think people realize what we have do deal with in the course of a day. I'll often say to people that if I don't get bodily fluids on me during the course of a day, I obviously haven't been to work. Most days I'll come into direct contact at least with feces and blood. Urine and pus are not uncommon. And anal gland secretions are a necessary risk; I have my finger in the rectum of multiple pets per day.Large animal vets have it even worse. They walk around in barns or fields with an inch or more of manure. Much of their day is spent literally up to their shoulders in the back-end...
