Monday, June 25, 2012

Don't Ask Me My Opinion if You Don't Want to Hear It

It is Monday, the last one in June. I am feeling a little forlorn about the idea of being half way done with summer..It is running away from me..

Today had the potential to be a slightly insane day. One of the vets is on vacation at the beach, and another is moving to NC, so we are down 2 vets and it is summer, and it's Monday. The perfect storm seemed to be looming before the doors had even opened.

I got up early, did my usual Monday half-hair-do and make-up combo, gulped a coffee and headed off to tackle the day.

My first surgery for the day was an old Shih Tzu with all of the usual problems of an old Shih Tzu. Crotchety, poor vision (due to chronic KCS which is dry eye due to decreased tear production, dry corneas, and constant chronic infection of the eye), poor coat, pot bellied, bad teeth, and throw into that picture of imperfection; Cushing's disease. She is owned by long term clients, whose mom I adore and whose dad I can't seem to quite understand whether he hates me, hates, animals, or just seems to hate everything in general. Her name is Blossum. (A wonderful name for a slightly pig-like looking low to the ground, snorting grey beast). Unlike most of our other Shih tzu patients, you can pick her up and she won't bite you.
      link to explanation of KCS:
      link to information about Cushing's disease:

With her age and progressive disease accumulation she has developed wart like lesions dispersed all over her body. I see these a whole lot especially in dogs as they age. They resemble warts except most of them are filled with a sebum (we call it cheese-like consistency material) and although they can change in shape and size and grow over time, they are benign masses. A benign mass is something that will not spread to other parts of the body or invade local tissues and cause damage. Essentially I tell my clients that they are "cosmetic defects." We usually monitor them and remove them only when the pet needs another surgery. Because we usually don't risk anesthesia for cosmetics. If they start to grow fast, change shape, or impede the pets ability to function normally, (like gets in the way of something) then we discuss taking them off as a stand alone surgery. For Blossum this meant that the wart-like lesion on her forehead was getting in the way of her upper eyelid. It was also very, very, unsightly, (every girl identifies with this). We scheduled her for the mass to be removed today. I was concerned about her surgery because of her age and other diseases but her family wanted it off in spite of my worries.

Her mom called the clinic at nine am to confess that her husband had fed Blossum by accident at 7 am. I advised that we re-schedule her for next week. I figured she had enough complications not in her favor already.

My first patient of the morning was Browne, a sweet happy 12 year old golden retriever. He came in yesterday for lethargy and inappetance. His owners confessed that he had eaten two Aleve pills that had dropped on the floor on Thursday. Aleve (see my top ten drug toxins) is very very dangerous for pets. (Please never ever feed your pet anything without asking your DVM first, you can call us, and remember better safe than sorry). When I saw him this morning I knew he was in bad shape. He was laying in his cage, reluctant to move, and breathing too hard and too fast. His gums were very pale and I knew immediately that his gastro-intestinal distress had turned into a gastro-intestinal perforation. He essentially had a hole in his stomach and that hole was bleeding into his belly. He was bleeding internally and if we didn't close the hole very soon he would die from internal blood loss. I called his mom to tell him that I was very worried about him and we needed to do an emergency exploratory surgery to close his perforation. Her reply to me was, "shouldn't we just put him down?"

"Umm? No. This is treatable." I wasn't expecting to hear her want for abandon, and I started reeling about what to say next. I told her that I would call her back after I had his blood work results.

A few minutes later the blood work confirmed that he was bleeding. He had a low red blood cell count and life-threateningly low protein levels. He needed an emergency surgery now. I called her back to discuss my thoughts, concerns, and offer my treatment plan.  She asked me "What would you do if he was your dog?"

Without hesitance I replied "I would take a look into his abdomen and close his perforation. This is a treatable problem. As long as his body is strong enough to withstand this surgery."

She replied with, "I don't want to hear that. He's 12 years old, and I am a teacher, I don't get paid in the summer."

I told her that I "couldn't use age as a reason to deny treatment." I shut my mouth, said a little prayer to the gods of medical intervention and waited.

She called her husband and then called me back to tell me that she wanted him put down. She was crying and I was disappointed in her decision, and reeling about how to figure out a way to give him a chance when his owners believed that he is too old to treat any longer. I shut my mouth again, and hung up the phone.

I am trying to learn the lesson the universe seems to be grilling me on. I need to be respectful of others decisions with respect to their pets. I need to have some faith that they care about their pet, and that my assumption that if it costs a nickel or somehow burdens them in any uncomfortable way that they are not simply disposing of their problem on my already heavy, self-doubting, half broken heart. If I give up on mankind I will suffer the fates of the mentally bankrupt insane. I apologized to Browne, told him that I loved him, and that he was a very good boy. I cursed my own existence and walked away.

I went to Mary Jane's cage to change her splint and take out my frustration on a purring kitten. If there is anything that can convince me to not jump off the ledge it is this alone. She did the trick in a half a second. She is a 2 pound tortoise shell lump of affection. She has a broken leg and could care less about it. The leg is a little out of alignment but she stands, stretches, plays, jumps, walks, and is too little to correct in our hands. Actually, I would argue that I wouldn't suggest she be messed with at all regardless of whose hands want to try to fix her. She has normal nerve function and normal use of her leg. It is also healing well from where the broken bone busted through her skin.

She was brought into us 5 days ago from Animal Rescue. She likely had some terrible trauma happen to her, as it takes a great deal of force to separate the bone from its growth plate. Her problems were: First, she had a compound fracture, (this means that the broken end of the bone cut through the skin). Second, a compound fracture adds the problem of an infected wound to be added to your treatment plan. I worry far more about infection in these wounds than I do the bones healing. Third, she is a cat, and I have 6 upstairs that no one seems to want, and they are problem free. Fifth, because of her open wound we cannot cover up the wound by placing the broken leg in a closed splint or cast. Bandaging over an infection will provide that infection with a dark moist closed environment and the infection will in response start reproducing like gang busters and a few days later you have a smelly, sometimes untreatable wound disaster on your hands that now is only treatable by amputating. Lastly, Mary Jane was too little to use any of the normal bone fixation devices on. The smallest bone plate made still is to large for her, and weighs more than she does. She needed to be treated for infection then have her leg fracture addressed.

I have learned that most kittens that have functional and ambulatory lives will heal very very quickly without much human surgical intervention. Provide them with a safe, warm sheltered environment and some basic cheap antibiotics and they will heal like a miracle.

I called Grace at the rescue and told her that I wanted to keep Mary Jane for a few days.

I changed Mary Jane's bandage today as we have done every day since she arrived, and sure enough her wound is almost completely closed. Her bone is starting to heal and she is playing like every other 2 month old kitten does. She is a joy to watch, cuddle, and marvel at. She is a love, and she brought me back to the point of feeling like I am not just trying to convince the world to care.

Sometimes it is just a tiny ounce of intervention that saves a life and reminds you that there is joy in the little miracles.

Mary Jane's tiny Tim brace is made of a half a tongue depressor and two pieces of tape. She needs this for about another 2 weeks. I expect by 4 weeks that her broken bone will be strong enough to not need a support. All I have to do in the interim is NOT fall in love with her.


  1. So sad if something treatable doesn't get treated.

  2. Kittens are good veterinarian's medicine :-)