Monday, March 5, 2012

Another Polydactyl Monday

Today was Monday. Everyone's favorite day of the week.

We at the clinic, like many of us, head off to work on Monday's with a plan in mind.

For the Jarrettsville Vet Clinic crew we usually have three plans in mind when it comes to Monday. They are as follows;
Usual day at work (the kind we all hope for),
best day possible (the scarcest of the three types),
and worst case scenario (our usual).

None of us really know or understand why scenario number three is our most common Monday, but few would argue the truth in my last statement. I load up the staff, I leave room in the schedules for the last minute emergencies, and I keep my day intentionally light so I can jump in to the pandamonium should I need to.

Today I woke up early as I always do on Mondays because my husband has to be at work by 9 am for his weekly meeting in Baltimore City (an hour away with no traffic on I-95). I got dressed, met Amy at 6 am for our 4 mile run, (today's 6 am temp was 28 degrees, for those wondering, I am always happy if it is more than 20 degrees). Finished our run, had coffee, shower, and met Karina, (aka my gift from the heavens), who helps me keep the laundry done, and the floors visible. She has become my necessity and my most treasured gift. She helps me with the house three days a week (everyone else thinks this is excessive, I want her for 7), and today she helped me with the JVC office.

Wren, her morning playtime. This is ALWAYS when I need to take a shower and she wants to play.
The tissue paper is a big hit with the kittens. It won't last another day,

I wanted to bring Karina to work because of last weeks events.

My dad our Hospital Administrator, (long story, I will talk about it some other time), seems to be burning through printers at a record speed. He is 1 person going through 1 printer a year. He loves paper, and he prints it in reams, I seem to have a new virgin pile, care of his printer on my desk, every time I turn around. Well his computer died again on last Wednesday. I spent an hour trying to coax it back to life, which I actually did for a whole three hours. But after it died a second time I referred this case to my computer specialist, aka husband, Joe. Friday, said printer came home for an autopsy (we call it necropsy in vet med, do they call it computeropsy in computers?) As soon as Joe opened the computer up three mid-size cat equivalents of cat hair erupted. "Damn It!" I said to myself, "I spent an hour and a half to to figure out a printer problem when all it was was a trichobezor?" (fancy veterinary medical term for hairball). After my husband screamed for 20 minutes at our despicable housekeeping I decided it was time for a cleaning intervention and today Karina went with me to work to vacuum.

I had planned on a peaceful day to try to get the offices cleaned, organized, and hoped to have time to write up my staff monthly staff meeting notes. As usual and as my fate would have it, this was not to happen.

The change in my perfect Monday plan started to unravel in part because of an email I received from one of our clients on Sunday.

(Actually he had emailed me on Saturday but for whatever reason my email provider thought he was spam and filed his email accordingly). So at 7 am Sunday morning I replied to his email which read as follows;

"I have a suspicion that my dog may have eaten a sock recently. She has vomited her water, having difficulty going to the bathroom, not eating, and looking lethargic. Can you please advise? If possible, I would like to bring her in tomorrow. Please contact me via cell phone if you think I should bring her in sooner. Thank you for your attention." 

OK, I know that you are all thinking exactly what I was thinking. "This sounds bad." I called him back and told him that if she was not acting normally, or was lethargic, and not eating that she definitely needed to come in today. (JVC is open on Sunday's 1-3 pm). I told him that if she was reluctant to move, or seemed dehydrated then she should go immediately to the ER. He said she was a little quiet but not depressed to that point. I told him not to feed her and be at the clinic at 12:45.

He and his black Lab (aka sock-eater) Heidi arrived on time and I saw before me a bloated black Lab who seemed terribly anxious, and was difficult to handle. Luckily, she was nice and pink, (color of her mucous membranes), her heart rate and breathing were normal, and she was only mildly painful on her abdominal palpation. I explained to Heidi's owner that "x-rays are great for bones, but not so great for soft tissue." I told him I would like to start with an x-ray and then take a look at her belly with the ultrasound. We agreed that an x-ray and ultrasound, (lucky for me Dr. C was in the house with another patient so I could have her scan the belly for me) were the best diagnostics for Heidi at this point. A few minutes, (and 1 muzzle) later we had an x-ray that showed her diffusely gas filled intestines. We call this consistent with an "obstruction," or "obstructive pattern." Dr. C also saw evidence of an obstruction on the ultrasound.

Heidi seemed to have much of the evidence we use for diagnosing an obstruction, but she was very stable.  I explained to him that I have seen gas patterns that look like obstructions be end up being simply gut stasis when I opened them up. Gut stasis means that for whatever reason the muscular intestines are not squeezing the ingesta caudally (to your colon). Because we are only open for 2 hours on Sunday, and because we only have three people in the building I suggested that we give her some SQ fluids, an injectable NSAID, and have her come back in the morning for a re-check. I told him that at this point I felt we were most likely going to have to open her belly up and go looking for that sock if she looked the same, or worse tomorrow.

So this morning my quiet day already had an exploratory, staff meeting, and housecleaning on the agenda.

Mrs. Butcher had called the clinic on Saturday to see if I could fit another one of her stray cats into my surgery schedule. She is a wonderful client who is trying to get the cat colony her neighbors have provided her with under control. I never say no to her. I want every last Harford County cat spayed and neutered so I don't have to hear about the shelter having to euthanize kittens, or cats, because they don't have room for them come July.

She then called at 9 to say she couldn't catch her stray cat. The front desk sent me a text to remove 1 item from the list.

I crammed the staff meeting notes into the shower and coffee time slot, and by 9:30 I had this crossed off my list also.

Mrs. Butcher called back at 10 to say she "got her." 1 item back on the list.

By 10 am I was at work and Karina was already vacuuming up the office dust bunnies. Check 1 item off the list.

Heidi was a different dog at 10 am when I saw her. She had her waistline back, and she was not a frantic basket case dog anymore. Her x-rays looked a whole lot better than they had 12 hours ago. I called her dad and he told me that she had gone out last night and pooped. "Great!" I said. "That means things are moving in her gut to some extent. Her x-rays also look better. Why don't we just keep her today on i.v. fluids, antibiotics, and see how she looks at the end of the day? I expect that you can pick her up at 7:30."

He agreed, and she did great all day. Belly is comfortable, peeing normally, no vomiting or diarrhea. But we didn't feed her anything today, so I expect the gut to be quiet and not produce any vomiting or diarrhea. The true test to decide whether or not she is not going to make a trip to the OR table happens tomorrow when we start to offer her small meatballs of i/d (the prescription diet for gastro-intestinal disease) and see if 1. she eats them, 2 she keeps them down, 3 they pass through her.

I'll let you know tomorrow.

There was still Mrs. Butcher's stray kitty "Sunshine" to take care of. Sunshine is a 6 month old, scared because I have never been handled before domestic medium hair orange tabby. She was not outwardly aggressive, but I do not challenge a cat (feral or not) to bite me. At JVC we play it safe by giving them a sedative in the muscle that knocks them out to the point that we can intubate them. This is as minimal handling as you can get, and it works great. The down side is that you cannot (usually) do any kind of physical examination before you give the sedative.

I don't take chances with a feral cat, or any unvaccinated cat, because I am concerned that if they do bite me, and they aren't vaccinated, that I may push a client into having to make a terribly difficult decision to euthanize their cat, because few will be willing to house a feral cat in a quarantined area for 6 months. This is the time frame most government authorities use to ensure an animal doesn't have rabies. I prefer the "keep a safe distance" approach.

Turns out Sunshine is the daughter of the kitty I spoke of in my Hemingway article, Mittens. She is also a polydactyl. This time I successfully convinced Mrs. Butcher to let me laser off the two thumbs that were between her normal foot and the extra toes. These toes couldn't be shed in the usual manner because this kitty wasn't able to retract or use these toes normally. At 6 months old the nails on these toes were already touching her foot pads. I lasered off two nails and gave her an injectable antibiotic. I hope this keeps her otherwise oddly looking feet fully functional and non-problematic.

The staff meeting went fine. (Cross last item off list).

We all ate a piece of the most beautiful and heavenly rich chocolate cake I have ever seen. Made by hand from one of our multi-talented RVT's. I happily gave up most of my dinner calories to enjoy a small piece of her creation. It was worth a weeks worth of dinners.

And we laughed at the silly things that this job consists of.

Today's best laugh was when I announced to the staff that I wanted all of our pets to find their own home. You see some of the staff has gotten particularly fond of two of our cats, Buddy and Kiki, and they don't want me to let them be adopted. The argument presented for keeping them is that they have a devoted following amongst some of our clients and that because they are always at the front desk they help us raise donations for the rest of our charity case clinic pets.
"Well, I said, If we could find homes for these guys then we wouldn't need donations!" This was met by universal laughter.

Kiki watching the hands of the clock move, or waiting for his shift to end?
For the record, all of the JVC pets, except for my cat, Dusty, are in need of a loving home of their own.

Buddy and Kiki playing

Missy, the constipated, megacolon cat, went home today. We went over her treatment regimine and I feel pretty confident that she will stay on her lactulose and cisapride, but the diet, well, I know he has a hard time with that because she is in a room with soo many other cats. She was very happy to see Mr. Biser, her dad.

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