Hit By My Own Car

Being a veterinarian means you wear a lot of hats, everyday.

Most of us vets are what we call "general practitioners."  A quaint little way of saying "jack of all trades, master of none."

Truth be told, I enjoy having a broad spectrum of basic knowledge. But every vet has their own particular strengths, weaknesses and areas of interest. I am lucky to work with 5 other veterinarians who all have their own honed skills and resume of experiences. We often work together collectively and will tackle the cases that require multiple brains with our multiple own perspectives and this ultimately always benefits our patients.

At Jarrettsville Vet I am the surgeon. It suits me just fine. I enjoy the tedious challenge, the never-the-same-problem twice individuality of every case, and the cosmetic aspect. I like to take the puzzle pieces and put them back neatly, and prettily in order, not losing site of function, of course.

Sometimes the surgeries are what we term "routine." A spay, neuter, or a small skin mass removal, these are the daily bread and butter. The surgeries we don't think much about, get too excited about, or fret over.

The once in a while trauma cases, those are the toughies.

Trauma, when I talk about this in veterinary medicine I separate them into two categories;

1. Motor vehicle meets pet. 

OR,

2. Mammal meets mammal. Whether it be BDLD, (our acronym for big dog vs little dog), or wildlife meets pet, or human being is abusive to pet.

Let's discuss category number one today.

Twenty years ago HBC (hit by car) was a more frequent, more likely to be fatal event. 

In my opinion a few things have happened to change the once grim statistics.

• More people spay and neuter, and therefore, fewer pets wander.
• More people use home containment devices (invisible fence, etc) to keep their pet within their own property.
• Almost every municipality have shelters and actively pick up roaming pets.
• Many people will stop and try to help a wandering or injured pet.
• Veterinarians who specialize in surgery and can correct almost every broken bone in the body.

But here's the trauma that I do see happening now more often these days.

Household-induced trauma.Specifically, I see more and more pets being injured by automobiles that belong to the pets own family. These are tough cases on many levels. The family feels guilty, they feel terrible about inflicting pain and suffering on their own pet, and they have to be clear headed enough to be able to make decisions about their pets care.

If there is one wish I could make with today's blog it would be to be diligent and careful and not to assume that your pet understands that a moving car, or lawn mower, or piece of farm equipment, or anything that moves, or has moving parts, is a threat. No matter how slow or how fast it moves your pet is curious and unable to comprehend circumstances, I don't care if they have "been hit before, and you think they have learned their lesson." They haven't and they will be hurt again, or worse yet, maimed or killed.

This is the story of Mac. He was seen lying on the driveway as his family started the car and began to back out. They heard him yelp! and they stopped the car to find they they had run over his tail and ankle.

Abrasion wound to the inside of the ankle.

Mac was brought in immediately after his family injured him. He was examined, x-rays were taken and he was started on pain medications and antibiotics. Luckily nothing was broken. He had a few abrasions, some with open wounds, a moderate amount of soft tissue damage, which included bruising and a few small areas of bleeding. All of his wounds were cleaned and dressed and he was scheduled for surgery the next morning.

The end of the tail is filleted open and there is damage to the fibers that surround the tail vertebrae.

There was some concern that we would have to amputate the end of Mac's tail. We would have had to do this if the end of the tail was necrotic (not viable or dead tissue). Thankfully, Mac's tail tip was still pink and he had feeling when you pinched it.

I have had many discussions over the years about how best to treat tail tip problems. There is a condition in dogs that we call "happy tail." This happens when a dog wags their tail so much, and in close enough proximity to a hard wall, that they break the blood vessels in the end of their tail. Or they hit it hard enough and often enough to cause the skin on the end of the tail to open. It can be a very frustrating ordeal to treat. Try asking a happy dog to stop wagging? Or try affixing anything that can, or will, stay on to the end of a wagging tail..not easy tasks.

Every vet has had to deal with this problem, and just about every one of us has had to amputate a tail or two because we either can't get that tail to heal, or the client loses the ability to try any longer.

The first vet Mac saw on the day of his trauma thought that maybe his tail would need to be amputated. She had forewarned his parents. It has been my experience to always try to keep from amputating a tail because I know how hard it is to manage them long term. If you ever think that this is the easier option please have a long talk with your vet before cutting..any happy dog with happy tail will keep wagging and keep busting open those sutures. Not only do you have to think about dehiscence of a suture, you also have to try to figure out a way to keep it bandaged..

When Mac came in the next day we removed his bandages to see how things were progressing.

The first big clue that Mac needed surgery was the smell that removing the ankle bandage produced. The bouquet of a simmering infection is a definable as the pus that it emits. Sometimes you only smell infection and Mac smelled of infection. Oddly I didn't see a wound that made sense with the putrid pungent aroma I smelled.

I knew right then that Mac would need surgery to find the source of the smell.

Mac's wound was very small..About half an inch long, and there wasn't any signs of bleeding, or the ever easy to identify pus. To an untrained eye (and nose) the ankle wound was small and unimpressive. But when Mac was placed under anesthesia we were able to make a very large pocket of fluid, about 6 inches long with the surgical scrub. The pocket was infection and it lay not beneath the skin where the small wound was obvious, but rather below the layer of muscle that appeared to be wound free.

Half of the drain has been placed. The drain must enter and exit at an area outside of the pocket of infection, but be in communication with it.The drains function is to keep the infection from remaining walled off under the muscle and allow a tunnel for both draining and flushing of an antibiotic solution.

Mac.
Under general anesthesia as we prep his wounds for surgery.

The drain in above and below the infection.

His tail looked jagged and swollen but it was healthy tissue and I thought that a few simple sutures to keep the edges opposed were the first step. The next was just to keep it clean, protected, and watch and wait to see if it would heal on its own.

After surgery. 

Mac's tail stayed bandaged for a week. We checked it daily for the first four days, and then the owners changed it at home for the remainder of the week. The tail healed quickly and looks like brand new.

The ankle was flushed twice daily with a chlorhexidine solution. It is important to remind clients that we are flushing around the drain and not through it. The drain is a flexible latex material that keeps an opening around the infection. We want to keep the entry and exit hole open so that the wound can drain, and so that you can flush a cleaner around the drain and into the infections pocket.

A few last notes on drains;

• Drains need to be removed within 7 to 10 days or the latex starts to break down.
• Be very diligent in keeping your pet away from the drain, and never cut it on your own. Every once in a while the ends get cut, or chewed off and I have to go back into that wound that we have worked so hard to get to heal and fish out a piece of shrunken latex..frustrating and annoying, for everyone.

If you have any questions, or any story to share please share them.

For any pet question you can find me, and many other helpful people with many other skills, at Pawbly

If you are a pet person please visit us at pawbly and share your skills, thoughts, and help other pets and their people. We are a place for all things pet, always free. Or visit us on facebook, Many thanks for reading.

krista

Life Lessons' and the Vets' Voice

Can you imagine how effortless life would be if all of the mistakes we all made were accumulated, documented, taught, reviewed, and then cataloged  We would all be able to saunter serendipitously through the sunny side of life?

Why shouldn't it be that easy? I mean we all essentially have the same challenges, the same basic  path through life, we should all get together sit down to discuss the challenges life has thrown us, the big and little tumbles, and help each other avoid them.

Fashion, hairstyles, cooking, relationships, kids, the list is endless. Gosh, I am almost euphoric thinking about how blissfully simply it could all be.

In my own little way I am going to try to spare you from a few of the tragic mistakes I have made.

Call it my personal testimonial for your benefit. Here are some my personal suggestions for a long, happy, healthy life.

• OK, sunblock is a necessity. You will grow old and your skin will age you faster than anything else. Wear it everyday religiously and never use a tanning bed.

Sun burnt noses.

• You should recycle everything at least every three years. Head to toe. That includes hairstyle, all garments, and shoes. Truly. (Admittedly, I don't live by this, but I am not sincerely proclaiming myself to be fashion-forward, just fashion-aware).

This hair style didn't last long.

That's all I can say about the human side. The veterinary side, well, that I can talk about for years. For me to tell you all that you need to know on the pet side we need a big pot of coffee, a table full of snacks, and a thick college ruled notebook.

With every medical problem that crosses my threshold I decide whether it is an indigenous problem or an environmental insult.

You see we human beings can muddle up any perfect system.

For instance, we might forget to lock up 7 loaves of banana bread and your puppy sees opportunity to score, so he does. Lesson learned, if you think your puppy might disappoint you, don't give them the opportunity to do so. Those 7 loaves of banana bread cause the delicate pancreas to go into overload, it swells, it hurts, and it causes your dog to vomit until they are emptying their own juices onto the floor. The pendulum shifts and the body starts to shut down sacrificing itself to preserve its most valuable asset the heart, lungs, and brain. without immediate medical intervention they may die.

Our own "7 loaves of banana bread chow hound" bulimic.

Lesson number two. If your pet doesn't stay in your allocated protected home they are at risk to nearly every imaginable fate. Theft, and possible horrific consequences, trauma, and it's expensive and possible fatal consequences, and your pet, like it or not, is seen by the rest of the world as just another cog in the intricate blood thirsty food chain. Lesson learned; Keep your pets close to your hip at all times.

Our most notable HBC patient.
Hit by a truck on a very busy road when the child left to be responsible for her
let her out without being on a leash.
She ran straight into the road and was hit instantly.
She has found a loving home of her own and is thriving!

Lesson number three. If the label says "Do not use on cats." It is not a suggestion. It should say, "This is very likely to kill your cat."

Lesson number four. If the vet warns you to never use scissors when cutting out mats. She is kindly trying to tell you that every person that brings in a pet that she has to sew back together has told her the same thing, 'I'm always very careful."

Cutting out a matt.

Lesson number five.  Your pet is a life-long ever changing, ever challenging responsibility  With this comes great joy, great love, health and longevity benefits to you, and expense and ultimately loss. The success of their ability to thrive is up to you. Get lots of advice, socialize them from the first moment, and ask yourself everyday if your companionship builds a stronger safer life for them and the rest of the community.

My Oriole, who was a feral stray,and is now the sweetest love.

Linda and her pair.

The kids and Jekyl in a pig pile.

If you have a concern that your pet is not safe around others (insert anything into 'others') then get help immediately. Don't wait until someone, or something is hurt.

Both of the above dogs were attacked by another dog in their household.

Lesson number six. All things are possible with love and kindness, let them guide you every step of the way.

Alright, lesson six is for all of us.

Sadies, 3 pelvic fractures and still loves everyone

8 pm, 11/21/11
Sadie went to VOSM today for her pelvic fracture surgery repair. So she can walk again normally.

She is the sweetest most gentle girl, and we have all really fallen in love with her. I will send word about her once I have an update.

For now please keep your fingers crossed for her and send a big Thanks to VOSM and Chris for saving her. They are an incredibly generous talented bunch of people. We are all so grateful for her second chance.

I will add pictures and updates as I get them.




Sadie, 1 week ago, the night she was hit by the truck




Her radiograph from the day she arrived with us. the left side of her pelvis has the breaks, the right side is intact.


 Ok, it is 9:30 pm and Chris just texted me to say that he just finished with Sadie's surgery. What a long day for him. I feel terrible that he was working so long and late and hard for our charity case. It seems we always give him the hard, long difficulty surgeries.

He repaired Sage's fractures. See her story, (gosh that was a longtime ago). I remember me, Chris, and my very amazing tech, working on her from 7 pm to 1 am..That was a long night. I can't believe Chris still talks to me. I am a shitty friend. I would dump me.

I'll update you all as I get news. (Although I know Chris will call soon, but I will be in bed sooner) Goodnight world.

11/23/11

Sadie was brought back to us last night late. Because of very rainy weather and lots of traffic. She is a little wobbly on the three good legs and has a bandage over her right hip joint and a plastic e-collar to dissuade her from licking at her incision. But she remains optomistic and as energetic as ever to be loved. She is being cared for by one of my fabulous technicians, who told me when she got back to the clinic that she is getting attached to her already. (She has been her chauffeur for the transit back and forth to the surgeon). So my tech took her home last night to watch her, and so she wouldn't feel alone after her surgery. She wrote the following back to me this morning after I texted her to ask how she did overnight. "She's a perfect little angel. ;-) and doing well. I just keeping telling myself that she's really ugly." It is impossible to resist her big doe eyes and sweet affectionate demeanor. I think my poor tech has fallen hard. It is impossible not to with that face. I replied with the typical "lol." Because I know I can't resist her either.




The bandage over the incision of her right hip, (aka coxo-femoral joint)




Sadie and her chauffuer, (Who is beautiful but camera shy)



You can't resist that face! (My good friend sent me a facebook a message that said,,,"o, I have to squeeze her!" I know the feeling.

 Sadie will have a great Thanksgiving, and I hope you all do too! I will post her post-op radiograph when I get it, so you can see her plate. Very exciting stuff!

Blue's Second , (or maybe we are on his Third?) Chance at Life

Yesterday was Blue's big day!

My very good friend Chris (and IMMENSELY talented surgeon) came up to JVC to do his fourth ever PRAA (persistent right aortic arch) surgery, (because it is so rare). He has never even heard of this happening in a cat. I am sure it does happen, but based on the huge number of kittens who don't even get a small shot at life, I would guess the huge majority of cats with any kind of congenital birth defect fall to the wayside. They are merely labeled as "failure to thrive" and forgotten to die, or euthanized, or eaten by something higher up the food chain. Even if a kitten is diagnosed, (implying their owner spent a couple hundred bucks and a whole lot of TLC to get them to the "diagnosis" point) the odds of that kitten getting a $2500 dollar surgery are slim. (Only JVC would be crazy enough to do that!)

Chris and Jess right before surgery

Chris came in on his one day off and spent three hours with me huddled over Blue's tiny chest. Jess, his new mom has invested many hours, day and night, over the last three weeks, to get his body weight over 3 pounds. This is no small undertaking when you can only feed him watery-gruel in a syringe. His care puts "labor intensive" in a whole new light. When Blue weighed in yesterday, as we were calculating his anesthesia induction agents, he registered at 3-1/2 pounds. Jess was very proud of herself and elated knowing that Blue's chances were significantly better if he weighed more than 3 pounds. Seems every medical statistic for prognosis tips at 3 pounds.

I.v. catheter in place, i.v. fluids running, ventilator keeping Blue breathing, four gowned and gloved surgical personnel, and so began Blue's surgery. Working in a surgical field of 4" by 4" we gently opened up the left side of his chest and began the two hour investigation into finding our needle in Blue's elaborate, delicate thoracic haystack. His heart remained steady and his breathing solid even after we packed off the entire left side of his chest. That little 3-1/2 pound kitten held stead fast as four enormous (relatively speaking of course) human fingers fumbled around to find a dead fibrous strangling piece of tissue around the esophagus in the northern suburb of Blue's heart base. For two hours Chris and I searched. We questioned our diagnosis, we questioned Blue's history, and we debated where we had gone wrong because for the life of us we could not find that piece of tissue. There were multiple points at which we debated giving up. But between the two of us, we took turns probing, re-positioning, and volleying new ideas back and forth. Then mircaulously, and with the help of Dr. H and an endotracheal tube down the esophagus, we finally found and transected the congenitally important but now lifeless tourniquet. What an amzing moment it was to see that trach tube pass into his esophagus without interuption at Blue's heart base! He could now swallow solid food for the first time ever.



One big finger in a little hole in little baby Blue's chest

A short time later the chest was closed, the room air evacuated, and the left lung field re-inflated. And then a few assisted breaths later and Blue was up and complaining. Within two hours he was begging for his now very late breakfast.

Blue 2 hours post-op

One day post-op Blue is trying to get used to a new opened esophagus. His brain is telling him to eat! eat! eat!, but we are still asking  him to try to take it slow. There is no convincing a cat of anything. So we have instead decided to offer little hors d'oeuvres of food every hour. The old adage, about "not rocking the boat" too hard is not what Blue wants to hear. Blue is feeling great! His incision isn't bothering him, he is purring, and playful. But he has a mild left sided facial paralysis which is probably the result of those big human fingers pushing tiny unidentifiable nerves out of the way. This should resolve soon.

He is the same happy, voracious, vocal, and bratty kitten he was yesterday pre-op. I expect the voraciousness will resolve as he becomes a normal feeding kitten, and the brattiness is fine with Jess. So maybe those happy endings really do exist?

Many Thanks to Chris, and VOSM, and the staff who donated their time, talents, and cajoling for funds.

As fate would have it for me. Two hours after we finished Blue's surgery a 5 month old Cocker Spaniel mix puppy came in after she was hit by a truck that fractured her pelvis in 3 places. She needs $3000 of surgery to walk again. Anyone got a bulging bank account? and/or a surgeon who owes you a favor? I am low on both for a while.

Here is Sadie, our next cause..

Here are some pictures of Blue from today, 11/21/11, 1 week post op. He is really doing amazing! He just started eating on his own, his eye is getting better, and boy is he happy!

His incision looks great! Yay for Blue! we got another donation for him today, many Thanks to everyone!



Blue 11/22/11

Very happily eating REAL SOLID food on Dec 7, 2011

Pets with Santa, Dec 5th, 2011. Blue with his two mommies.
Unable to focus on the camera because all he wanted to do was play with Santa's pom-pom.



These were taken 4/16/12. Because his mom brought him into work after he ate, and started vomiting an art eraser. Bad Blue! He is doing great, and he coughed up all of the eraser within a few hours.

Update;

Blue just celebrated his second birthday. He is fat (not so happy about that) and very happy with his second mom.