Wordless Wednesday (Another Failed Attempt).

Driving to work on Sunday.

Jekyll riding booster seat shotgun.

Thankfully, we never get on a major road and we are never traveling more than 40 mph. 

Like it, or not, I am holding him the whole time. 

Nothing beats a happy patient.

I was a bit concerned about how red his ears were (allergies, infection?).

"Nope," his mom said "excitement."

This little one needs a home.
He is renting a small pad in the lobby.
He purrs on sight, rolls over immediately, and will charm you faster than Casanova on his best night.
And that little mustache!! Oooh, so cute!

My Magie.

Looking coy and a bi devilish!

She was actually attacking my toes.

"Ouch!"

Wren and Magpie, making it almost impossible for me to work.

Until they decided that work was boring.

So they napped, of course.

Little baby Bo. 

Just rescued by a couple who cuddled him, cooed over him, and 

said that they were "going to try to find him a home."

Personally there was waay to much oogling over him for me to believe they can part with him.

"Good Luck letting him go. He's too adorable. I'm a softy too."

A happy to be at the vet pup.

Porter, the IVDD dog. Who motors around with his own little twist, but never stops to feel sorry for himself or wonder why life threw him a wrench.

He is a true testament to,

"Get up, work hard, be grateful, and live in the moment."

Little Dottie.

Here for her kitten vaccine.

Feeling very safe with her mom.

If there was anyway I could do it I would gift myself a kitten every year.

Buddy at his post.

He is the king of musical chairs.

If you get off of yours he will be in it before you can shoo him off.

Elliott and his x-ray. He is four weeks post-op.
He has no limp and he, in true kitten fashion, has healed quickly and completely!
He will be in on Monday to have his pins pulled.

This is Kits x-ray. His brother, who also had a broken leg.
Fixed two weeks ago.
Pin removal (if possible, I am very worried because they are in the knee joint.
I have to try to dig them out on Monday.
Stay tuned for this one too).
Why do I do this to myself?
I will be stressed until they are out.

Happy Hump Day!

If you have a pet related question you can get an answer (and also find me) at Pawbly.com on Twitter @FreePetAdvice or @pawbly.

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.

Blue, and His Many Miracles. His PRAA heart defect, and how his regurgitation identification was the key to his diagnosis.

We met “Blue” four weeks ago when his mom came in to try to understand why he was vomiting so much? It seemed that he was always hungry and would eat voraciously, and then a few minutes later would “vomit” up most of the food he had just eaten.

In the scary Third Year of Vet school we all take “Gastroenterology.” It, (if you go to Virginia-Maryland) is taught by the ever-challenging Dr. Leib. One of the first things he drills into our brains is that you need to distinguish “vomiting,” from “regurgitation.” “Vomiting” means that you are emptying the contents of your stomach through your mouth. This is what most of us have encountered with food poisoning, motion sickness, the "oops, I had too much to drink" episode. “Regurgitation” is expulsion of the contents that haven’t made it to your stomach yet because they are being held in your esophagus. This means the food never gets to your stomach and your stomach isn’t doing its "heave-ho-muscular-squeezing" action to force out the contents it doesn’t want. Regurgitation is a passive looking "food-just –seems-to fall-out of your mouth" action, whereas, vomiting is a muscular contraction of your stomach to expel its contents. Sometimes it takes a lot of explaining and some funny looking demonstrations to identify which of these is happening in a pet. For Blue it was the most important diagnostic key for us to uncover. For Blue it was the difference between “most likely easily treatable” and “really really bad.”

We very quickly learned that Blue was regurgitating. He was having great difficulty getting the food, he so desperately wanted to eat, into his stomach. It is like torture. You eat and eat because you are legitimately starving. But you can’t get the food that you are devouring into your belly so that it can provide you with the nourishment you soo desperately need when you are a very young growing kitten.

At his first appointment it was very clear that he was underweight, undernourished, and desperately hungry. These are all tell-tale signs of a pet with regurgitation issues. Once we classify that you are truly regurgitating and not vomiting we can start to identify what is causing the problem. The big key is that the problem lies in front of, (or towards your mouth), and not from your stomach or below, (towards your tail). In most cases it is a problem in, or around, your esophagus.

Your esophagus is a muscular tube that pushes the food that your mouth swallows into the sac (aka your stomach) so your stomach can then churn and digest your food. If your tube (esophagus) doesn’t squeeze the food to your stomach then it just sits in the tube and the tube responds by getting wider and wider, like an over-inflated bicycle tube. The more air you try to put into your tube the more stretched it gets. This sometimes happens if you have an obstruction in your esophagus, or if something around your esophagus constricts it. This second scenario can happen if your heart doesn’t make the appropriate changes it needs to make after you are born. This is called a congenital (you are born with it) “vascular ring anomaly.” It is a malformation of the hearts vessels that entraps the esophagus and acts like a rubber band around the esophagus. The longer you keep a constrictive band around your highly dynamic muscular tube-like esophagus the more that tube will stretch and dilate in front of the tube. This is called a persistent right aortic arch, or PRAA. This anatomic “ring” occurs at the base of the heart and becomes apparent as babies switch from milk to solid foods. Affected patients become weaker and weaker and more malnourished as time goes on. You will die if it is not corrected surgically.

Back to Blue. Blue’s very unique diagnosis (this is the first any of us have ever seen), also came with a very unique story as to how he got to this point. So all the way back to the beginning we go.

Blue was brought in by his parent-mom after she witnessed his mom being hit and killed by a car. Blue was still in his mother’s mouth when she was hit with his umbilical cord still attached. He was taken home and bottle fed by his new mom. After a few weeks of being bottle fed they started to transition him from the kitten formula to solid food. It was then that he began to regurgitate. This brought him to us.

When he came into JVC we discovered that he most likely had a PRAA. The treatment for this is surgical correction ASAP. This surgery requires that we open the chest and remove the band of tissue acting like a tourniquet around the esophagus. Ok, if that doesn’t sound so incredibly difficult then please remember that Blue’s chest is about 2 inches by 2 inches, that the constrictive band is tiny, and that we have to keep his heart beating and the lungs working even while our fingers fumble around in a chest that is supposed to be a vacuum, (can’t be exposed to air, need a ventilator to do), and NONE of us Vets EVER go in the chest because very bad, scary, life ending things happen there. Without this surgery Blue will not live. Only a few Vets are qualified to perform this surgery, (or have ever done this before), and to have it done costs about $3000.

Blue’s mom realized that she couldn’t afford this and brought Blue in to have him euthanized. It is incredibly difficult, and so far for me impossible, to euthanize a treatable pet. I can’t do it. I always feel like I have to at least try. That day I told her that she could sign him over to us and we would TRY to find someone to do the surgery for him.

Jess my technician has taken over his care, and feeds him with a syringe every 2 hours. They have gotten very attached to each other. And the staff, led by Cindy has raised about $400 for his surgery.

This is an x-ray of Blue. He is lying on his side. We put some dye in his food and then had him eat it. The white is the dye. It stops at the base of the heart. then you can see it again in the stomach.

Blue’s surgery is scheduled for Monday Nov 14, 2011. Three Vets are donating their time and surgical skills to provide this. The very talented, skilled surgeons at VOSM, (Veterinary Orthopedic Sports medicine in Annapolis Junction, MD) will save his life.

It is one of the many cases that have been saved by my devoted, compassionate staff, and a few good friends.

If you would like to help contribute to Blue’s care, or any of the other pets in the care of JVC please see our website www.jarrettsvillevet.com, or call 410-692-6171, ask for Cindy and tell her that she is amazing, Jess, and Dr.H too! And if you REALLY want to make someones day call VOSM and tell them that the world is a better place because of people like them, who give even when they don't have to.

Thank-You for your generosity to those of you who have already donated and Thanks to everyone else for your well wishes.

Here is some information from Tams text book on Gastroenterology