We cried

It's been awhile since I posted and it's not for a lack of trying or due to a lack of things to talk about. It mostly had to do with giving myself some time and space to process things recently. A lot has happened since my last post ... holiday season has started, a new president-elect has been chosen, my Panthers have continued to disappoint me, my Buckeyes have made me proud and my wallet has been emptied of hard earned money in an attempt to surprise my daughter with a mountain of gifts on Christmas morning. And in the midst of all that I continue to practice medicine day in and day out - some days good and others bad. This time of year the bad days seem to out number the good ones. The holiday season brings with it joy and happiness, but in veterinary medicine if often brings a large amount of sad stories, unfortunate accidents and too often to count, excrutiating decisions regarding patient care due to financial constraints of the holidays.

I follow other blogs online, mostly veterinary oriented because let's face it....the only people who can truly understand what we deal with is other people in this crazy field. I opened my email last week to see a blog post from A Vet's Guide to Life (http://avetsguidetolife.blogspot.com/). The title - "Death, death and more death". It was quite fitting to see this topic last week when I spent many days looking at my appointment book to see 2 or 3 scheduled euthanasias each day.  Most of these were not unexpected, a few being patients that I knew were drawing to the end of their lives but some were unplanned and decisions had to be made based on new information, new sickness or unfortunately lack of funds to care for the ailing pet. Even though I did not disagree with any of the choices that these owners made, it never makes the actual deed any easier. The hardest part of it all is having to compose oneself after these events and go on to the next appointment - whether that be a happy puppy or another sick pet. You have to pick yourself up, dust off the emotions of the last appointment and start over again in the next room. Exhausting to say the least.

I try to remind myself that I am helping to end the suffering of a patient and bring comfort to the family when they can no longer provide care for their pet - whether it be due to finances, quality of life or other unknown reasons. But to be honest, when you have to do several of these a day for several days in a row you want to just curl up in a ball and cry. Often I hear myself screaming in my head, 'this isn't why I went to school'. I went to school to make their lives better - to help these animals and their owners. To try to solve problems, cure illnesses, make patients happy again. And yes, euthanasia is part of that process.....just not my favorite part. It takes its toll on all of us.

The staff and I gathered around a particular case recently - a sweet labrador who was suffering from diabetes and pancreatitis. We couldn't manage to get either condition under control and more diagnostics revealed that she most likely had cancer contributing to her condition as well. Based on all this information her family made the tough choice to let her go. They wanted to remember her during her good times so they chose not to be with her at the end but I assured them that myself and the staff would be. The entire staff and I gathered around this sweet girl and treated her to a royal last meal - 2 slices of pumpkin pie, whipped cream, numerous buffalo wing flavored potato chips, chocolate candies and as many doggie treats as she could handle. I cried as I watched her enjoy this time with us - I cried not only for her, but for all the other animals I had to say goodbye to that week, for their families and a little for me. For the little piece of me that left with each and every patient I said 'see you later' to. The staff cried too....they may not have known what I was crying for but they knew it had to be big, cause truth be told, I just don't cry that often in front of them.  We all said our goodbyes as this sweet girl closed her eyes for the last time. Then we dusted ourselves off and did it again the next day......we look for the good in each day, even when it is difficult to see. Sometimes the good is simply the joy in a piece of pie..

More than Meets the Eye

When I was in ER practice I was often asked about what cases terrified me the most. Most people would imagine things like hit by cars or devastating surgeries or obscure toxicity cases.  Those could be scary but my answer was always the same....dog fights. Big dogs attacking little dogs, big dogs attacking big dogs or the worst of them all.....any size dog attacking a cat. Dog bite wounds still scare me more than anything else. And it isn't because of infection or spread of disease or even the obvious things like bleeding or broken bones. It's because these cases often look very simple. From the outside sometimes you may only see a few small, harmless-looking, wounds to the skin. It's what is happening below the surface that frightens me.

When I was teaching the interns at the ER hospital I always told them to expect the worst when it came to bite wounds. "It's the tip of the iceberg" we would say. That little skin wound is hiding a world of disaster below the surface. The cases that presented with huge open wounds were honestly the easy ones...often the owners could see the damage that was done. It was even better if there was a broken bone because that is easy to understand. But trying to explain to an owner that their dog or cat that appears fine and just has a few small wounds to its neck or abdomen could be in life-threatening danger is tough.

Humans produce about 150 pounds of pressure when we bite down on something - compare that to the average dog who ranges between 235 pounds of pressure (American Pit Bull) and over 300 (Rottweiler). Take that force and add in the length, usually around 2 inches in a large breed dog, of the average canine tooth (the long pointy one that usually does the biting) and you can see the damage that can be inflicted.

When we are examining the skin surface we are merely looking at the entrance wound - we don't know what has happened to the underlying muscle, fat or worse. Wounds present over the chest or abdomen can easily have traveled into the body damaging vital organs or lacerating important blood vessels. I encountered this several times in ER practice after taking a patient to surgery to determine any internal injuries - it still amazes me that a dog can look fairly stable on the surface and have catastrophic injuries internally. I have seen intestines ripped apart by dog bite wounds  and the only thing noted on external exam were 2 small puncture wounds over the abdomen. I once saw a pancreas torn in half - again the external wounds were pretty minimal. This is a perfect example where looks can be deceiving.

Our job as doctors in these cases is to try to uncover as much damage as we can - often this can be difficult especially if owners do not feel that their pets are in trouble or are seriously injured. A dog I recently saw came in for several dog wounds that occurred the day before. On initial exam the wounds were numerous and infected but it wasn't until we anesthetized the patient the next day to explore those wounds that everyone could see the extent of the damage present. If we had not opened the wounds up and removed all the dead and infected muscle and tissue we could have set this dog up for disaster.

So when good dogs turn bad or simple playdates turn ugly and Fluffy ends up with some bite wounds, please take the time to have your veterinarian take a look. They may be very minimal wounds but if we can't tell from the surface, how can you?

Original Presentation

Original Presentation

After wound explore

Thank your Tech today

Thank you to all our hard working Vet Technicians. We could not do our jobs without your hard work. You help keep us sane during the day, keep our patients comfortable, our clients happy and keep our hospitals looking beautiful. Thank you from the bottom of my heart

Something sounds a bit strange

"Something sounded strange when I tried to get a heartbeat", my technician recently told me as she described a  patient in a room waiting to see me. The dog was an older pet, 9 years old, and had come in for not acting right that day. He had been seen a few weeks ago for similar signs but nothing was found that day on his labwork or exam. Today the owner said he didn't really want to get up and was not interested in eating. So when my skilled technician told me her findings, my interest was peeked. As soon as our techs tell us information regarding our patients, we immediately start running a list of possibilities in our minds - its how we are trained to think. We go over abnormalities, symptoms, differentials, possible explanations and so on and so on.

The combination of an older dog who didn't want to get up and eat, along with the strange thing my tech described made my inner ER doctor come to life. I asked her a little more about what she meant - she said it was hard to hear his heart and that his pulses on his back legs felt funny. Small alarm bells start ringing in my head because I immediately know what I need to do for this poor dog and owner. I go in and approach the concerned owner and let him know that based on what he has described at home and what my technician noted on her initial exam I am concerned that his dog may have some fluid developing around his heart - a condition called pericardial effusion. I do my physical exam and notice that this dog's gums do look a little pale and his heart rhythm is abnormal. I tell dad that our next step to confirm things is to do a quick ultrasound to look for fluid around the heart. If we see some I will come back and talk to him about our next steps.

Our ultrasound confirmed what I had suspected - this poor guy did indeed have pericardial effusion - fluid contained within the sac surrounding the heart. Imagine the heart sits inside a thin balloon - usually there is only a small amount of fluid in that balloon but in some instances we get a large amount of fluid there. This fluid fills up the balloon and puts pressure on the heart, preventing the heart from being able to contract and pump normally. This leads to symptoms such as we saw today - lethargy, pale gums, disinterest in food, and difficulty hearing the heart when listening to the dog with a stethoscope. Imagine trying to listen to music through a wall of water - it would all sound muffled right? That's what it sounded like when we listened to this dog - everything was muffled.


We were able to drain the fluid from around the heart using a long needle (a procedure called a pericardiocentesis). We removed almost 1/2 liter of blood from around his heart.

This instantly made him feel better and when his dad picked him up later that day he eagerly walked into the room, tail wagging the whole time.  Often pericardial effusion is due to an underlying cancer somewhere and in this instance, a large tumor on this dog's spleen had metastasized to his heart which was causing the blood to accumulate around it. Unfortunately, the owners had to make the tough choice to say goodbye to their friend a week later.

I credit my great technical staff for noticing such a slight symptom and clinical sign - it was their keen awareness of what is normal and abnormal that tipped me off to know which direction to head in with this patient.  I was glad we were able to provide some relief to this patient, even if only for a short amount of time.

Video Games and Surgery?

I never really played video games growing up - it was never really my thing. I had a Nintendo gaming system (yes I am old) and we would play it but nothing like what some people do nowadays. My husband has a PlayStation 4 or 5 or 20...whatever the latest model is and he does play games from time to time. He invites me to play along with him but I generally decline and go on about my housework, or reading or watching trash TV. Imagine his dismay when I came home a few months ago and said, I am learning how to do 'video game surgery'.

Now it's not really video game surgery - but it feels that way. Minimally invasive surgery is becoming more and more common in veterinary medicine. It already is commonplace in human medicine and often laparoscopic or arthroscopic procedures are done in place of more traditional open surgeries. We know that these surgeries produce less pain, have a quicker recovery and less chance of complications. As with most things, veterinary medicine has lagged behind a little but we are now seeing more and more laparoscopic procedures being performed not only by board-certified surgeons but by general practitioners, like myself.

Why do I call it video-game surgery? Because we do it with a camera placed inside the body through various port sites and use instruments internally to do our work. We do all this while watching a monitor displaying what is happening inside the dog. It feels just like playing a video game or living in virtual reality. Either way...it's super cool!

We all know that elective spay procedures help decrease the incidence of unwanted pregnancies as well as prevent future illness in our female dogs such as pyometra (life threatening uterine infection) and mammary cancer. Most people envision the traditional incision on the belly from a spay as seen here :

What most people may not realize is there is an alternative - laparoscopic ovariectomy. The terminology is a little different in that with this procedure we are only removing the ovaries - we are leaving the uterus. However studies have shown there are no disadvantages to leaving the uterus and removing only the ovaries since it is the ovaries that are producing the hormones and ovulating. Laparoscopic surgery allows us to do our procedures through small incisions that heal quickly and cause less pain. It also gives us the opportunity to evaluate the entire abdomen for any abnormalities and perform additional procedures such as a prophylactic gastropexy in large breed dogs - this is a very important preventative measure wherein we suture the stomach to the muscles of the abdomen to prevent bloating from occurring in the future. If done traditionally, a gastropexy would necessitate an incision from the breastbone all the way to the pelvis to allow enough visualization to do our spay and the gastropexy.  Compare this to the incisions below, recently done, to do the procedures listed above. 

Three nice little incisions right? And I can tell you, this dog was up and bouncing around a few hours after surgery - definitely less sore than the traditional route. I'm lucky to work at a hospital that offers this newer procedure as an alternative to the traditional route. It certainly is less painful, quicker recovery and less chance of adverse events such as infection or breakdown of the incision site. For those considering upcoming spay procedures on their dogs I encourage you to talk with your veterinarian about this option. If you live in the Charlotte area check out our hospital and see if this procedure is right for your dog. Plus, it's pretty cool to say your dog had video game surgery, right?!?

An Open Letter to My City

My eyes filled with tears this morning at the events that are going on in my city the past few days. I am filled with an overwhelming sense of worry, of concern and of sadness for the people of Charlotte. I remember a few short months ago when our city was filled with a sense of pride and camaraderie over our beloved Panthers and their success. We joined in arms as we celebrated this great city we live in. People came together to be joyous. Charlotte...where is that feeling now?

I love this city.....yes I am a transplant and people may criticize me for that saying I am not a true Charlottean but I have been here since 2007. I consider this city my home. It is where I have chosen to set down roots, to get married, to raise a family, to conduct my business. It's where I want to see my daughter go to school, make friends, take part in city celebrations, and learn to love others. But the last 48 hours this city is not the same place I know and love.

No one but the people involved know the true story of what happened a few nights ago when that unfortunate incident set off a whirlwind of emotions. I do not claim to know whether it was right or wrong. I do know that what has happened since that day is just wrong. We cannot attempt to combat hurt and hatred with more violence, more hatred, more destruction. Attacking innocent businesses or innocent people does not justify the hurt that people are feeling. Have any of these protesters stopped to think that the businesses they are looting or destroying may be owned by people who share their same mind frame? That these businesses were not the ones to offset this sequence of events? How does punishing innocent people make any of this better?

My husband and I choose to raise our daughter with a sense of acceptance and love. It is how I was raised and I am proud of it. My daughter has respect for authority and knows that if she does something wrong there are consequences...a concept that seems to be lost these days. This overwhelming sense of entitlement and that we are all 'owed something' has to stop.  The American dream has always been that if you work hard you reap benefits....when did that morph into "I am owed benefits without hard work?" When did we all stop respecting others?

As I look at the images of Charlotte this morning and the destruction that has occurred I wonder when we will feel safe in our city again? I wonder how the police officers must feel as they go home to rest knowing that tonight may bring more hatred, more protests, more destruction, I say a prayer and ask for help. Help to know how to explain these events to my daughter, and how to make sense of them myself. I pray that as my husband ventures into uptown Charlotte today that he will be safe. I pray that as the police report to work today and tonight that they are safe. I pray that the people who feel injustice today find the peace they are looking for. I pray for the families of those that have been lost in the last several days. I pray......

Charlotte.....you are the city I live in and love. I know that deep down we are the city that came together 9 months ago to celebrate success. I pray that my few words reach someone who can make a difference today. I hope that my prayers and the prayers of so many others are heard today and our city finds peace. I pray that people remember how to love. I leave you with that word...LOVE

I'm back

I recently took a little hiatus from blogging to give myself a break. There has been a lot of talk about work/life balance lately especially in veterinary medicine. I returned from my vacation to see posts about yet another veterinarian taking their life due to the demands this career puts on us. I recently shared a video from Dr Andy Roark on my facebook page regarding this topic. And I knew I wanted to comment on what is happening in our field but I needed time to think about what I wanted to say.

It makes me incredibly sad that this career that I dreamt of  having since I was 5 years old is not quite what I had envisioned. There have been many, many times in my life that I thought I should have made a different career choice. I know that sounds terrible so please forgive me and let me explain.  It isn't because I don't love my clients or my patients. It's because the part about loving animals and being a doctor is the easy part of this career. Sure there are days when the  medicine doesn't go my way, or a patient doesn't survive despite my best efforts, or a patient presents to me and I just don't know what is wrong with it. Those days are tough and challenging. As Dr Roark said in his video, veterinarians are type A individuals and often perfectionists. We like to be right. When things don't go our way it is easy for us to blame ourselves and often we are our own worst enemies. We can often beat ourselves up for something that truly was not our fault.

What most people don't take into account is all the other stresses and pressures and challenges we face. We are often not very good at separating home life and work life. Take myself for example, it is not uncommon for my husband and daughter to find me at the kitchen table doing work on my days off or in the evenings. It may be simple things like returning an email question from a client, or updating the monthly schedule for our 11 doctors, or following up on some lab work I did on a patient. There are a lot of people who are able to leave their work at work......unfortunately I have never been very good at that. And even more unfortunate, I think many of our clients have come to expect us to be available at all times. There is a connotation that if we create boundaries from clients or limit our interactions with them when we are not in the office, that it means we don't care. It is a common belief that what you do for a living is who you are.

The problem lies in that I am more than just a vet - I am a wife and a mother, a daughter and a sister, a friend and a colleague. And unfortunately as we all find out at some point, I feel like I am sucking at all those roles. When I am at work I feel guilty for not being home with my family and when I am home I feel guilty for not keeping in touch with my clients. My workdays expand well beyond the 10 hours I am scheduled on the calendar (which is much longer than I would like as it is). I spend 2 hours a day commuting to/from work and then once I am home I am busy cleaning, cooking, doing laundry and spending time with my family. Beyond that I am also available to my clients if they need me - whether it be via text, phone or email.

I'm not saying all this to make anyone feel bad for asking my advice, or contacting me after hours.  I want everyone to be able to understand that often veterinarians are stretched so thin and we feel that no matter how good of a job we did that day, that it is never enough. We want to be the best doctor, wife/husband, mother/father, brother/sister, friend, etc that we can be. And yes....often our expectations are too high. Our goals are unattainable. We know that - it's that drive and determination that got us to where we are in our careers. But that drive can damage us more than we realize.

It's necessary to take a break every so often. Turn off our laptops and our phones. Ignore the facebook messages for advice. Sit in silence with a glass of wine or cup of coffee and just remember to breathe. Maybe lie on the floor and have a tickle-fest with your 2 year old daughter. Force ourselves to remember what is really important and realize that our clients will be there when we return to our 'regular lives'. If we don't take care of ourselves, we can't take care of anyone's furry friends. We owe this to ourselves.....

Would you like Bacon with that?

A few months ago I was greeted on my way to work with the following text message "Penny keeps vomiting and it contains gravel..........do you think I should take an xray?" Penny is an energetic Chocolate Lab owned by one of the technicians at work. As all labs do, Penny likes to get into trouble and on this particular day got herself into a LOT of trouble. I chuckled a little to myself before responding and letting my technician know to go ahead and get some xrays and I was on my way in.

I don't think either myself or my technician expected to see that on the xrays. That is a perfectly sculpted stomach full of gravel. I mean FULL. No room for anything else. Nothing was getting into that thing - nothing, nada, zilch. Do not pass go...do not collect $200. We put poor Penny on some fluids to see if we could make any headway on things ( I have seen gravel move through with just some IV fluids to help) but after a few hours nothing had changed. Poor Penny was destined to have a zipper installed on her belly (ie surgery time).

When it was all said and done I think we removed around 4 lbs of pea gravel from Penny's stomach (including the amounts she vomited before surgery and passed in her stool later on that day). Penny continued to pass some small amounts of gravel for a few days but by the next week was back to her normal labrador self.

I'm sure you are wondering why this sweet girl decided to take part in an all-you-can-eat gravel fest? A poor innocent family member who shall remain nameless emptied a container of bacon grease out the back door onto the pea gravel earlier that fateful day. Without thinking about it a few hours later, Penny was allowed to go out in the yard to do her thing. When she remained out there for a while, no one really thought much of it until.....well you know the rest. No dog can turn down bacon flavored gravel.  I think Penny learned her lesson and will stick to plain bacon from now on.

Small name, Big Heart

When I first met Shrimpy I envisioned something like this

Instead, I was greeted by an 80 lb American Bulldog who cowered behind her owner's legs in the exam room. It took some offerings of yummy cookies to convince Shrimpy that I was not as scary as she imagined. Once she sniffed me, and decided that since others had approved of me I must not be a  monster, she and I became good friends. Unfortunately for Shrimpy she was soon diagnosed with a rare form of lymphoma ( lymphoma noted in her stomach on an endoscopic exam). This type of cancer is tough to diagnose, because often there are no outward signs, such as the case with Shrimpy. It was diagnosed after Shrimpy developed severe bloody vomiting that could not be controlled with routine medications. 

Luckily for her, Shrimpy's dad is an outstanding pet parent and would do anything for his girl. He has been meticulously caring for her since her diagnosis and brings her to us for all her necessary lab work and monitoring. Shrimpy recently developed  facial nerve paralysis, a side effect from her cancer spreading to other parts of her body. The facial nerve allows us to feel sensation on our face as well as blink our eye and produce tears. Because her facial nerve is no longer working on the right side of her face Shrimpy developed an ulcer on her right eye. The ulcer, or abrasion to the surface of the eye, started out very superficial and we attempted to treat it like any other ulcer. Normally a dog's blink reflex and tear production will help protect the eye and help us treat any ulceration. In Shrimpy's case she lacked this normal protective mechanism so the ulcer and her eye were left open to the world for further damage. Shrimpy developed a desmetocele which is a very deep ulcer through the outermost layers of the cornea. It actually appears like a small divot in the surface of the eye as seen in the picture below

We attempted to do a temporary eyelid tacking procedure to provide some protection for her eye. Our hope was that this would allow enough time for the ulcer to heal. Unfortunately that did not happen and we elected to remove her eye a few weeks ago. Since her surgery Shrimpy has continued to do well. She always wags her tail when I see her despite her visual limitations. Her facial nerve paralysis has progressed and she has a head tilt now but she still loves to see everyone when she comes to visit us. We know that Shrimpy's time with us is limited but despite her small name, she has a big heart and we plan to get as much love from her as we can while she is here. 

Highlight Reel

Every couple of weeks I like to go through my highlight reel in my head - revisit the good moments from work and relish in the positive outcomes. More often than not I am occupied by thoughts of what I could have done differently in a situation, how I could have handled a conversation better or what tests I should have recommended for a patient. I am the master of beating myself up when things don't go the way I want them to so I have started allowing myself to glow in the positive things, the kind clients, and the grateful patients.

I leave for vacation this Saturday - it CANNOT come soon enough - so for the next few days I am going to share some stories from my highlight reel.

Hershey is a sweet 8 year old Chocolate Lab (hence the name!). She came to me a few months ago with a history of not acting quite like herself and vomiting. She did have a history of eating rawhides and so we decided to do some xrays on her. Her initial xrays were not very exciting and the radiologist did not see any evidence of a foreign body or obstruction so we treated Hershey with some fluids and medications to combat her nausea. Her tail was wagging when she left our front door and I hoped that she would continue to do well overnight. The next morning when I walked into our treatment room at work there laid Hershey. I instantly got a sinking feeling in my gut - I knew she was back because she was not any better today. Dad confirmed that she was not better, and in fact was worse this morning. She had continued to vomit overnight and this morning was extremely lethargic and even wobbly when she tried to walk. She was pretty dehydrated and depressed and it looked like her abdomen was distended this morning. BIG RED FLAG! I immediately admitted her to our hospital and repeated some xrays. The changes on her xrays were disturbing to me - she had big loops of distended intestines and I knew something was causing them to fill up with gas and not empty properly. We recommended surgery and her owners anxiously agreed. It is often a debate on our part whether immediate surgical intervention is needed - its easy when we can see the offending problem on xrays (such as an easily identifiable foreign body or a bladder stone) but other times, like this, it can be more challenging. I couldn't see the obvious cause of her GI obstruction but my gut instinct (no pun intended) told me to take this girl to surgery.

In surgery we discovered a rare problem - her intestines were twisted on themselves at their base (called the mesenteric root). Often dogs that have this problem develop large distended loops of intestines that quickly die and most dogs do not survive this problem. Hershey was extremely lucky that we took her to surgery that morning and that her torsion was only a partial one. I quickly untangled her intestines and they immediately began to look pinker and healthier. After surgery Hershey woke up feeling much better and was even wagging her tail later that day. She spent the night with us and by the next morning she was back to her happy 8 year old Lab self.

I am thankful these owners were so diligent about watching Hershey and that they returned when she was not any better. Because of their attention to her demeanor and symptoms, we were able to get her into surgery before her condition worsened. I am happy to say that Hershey continues to do well to this day!

Meet Keuchly

Meet Keuchly – He is a 1 year old cat who came to me with an infected fracture of his left hindleg. The owners were unable to afford his treatment and since he was so young and sweet I told them I would take him in and make sure he was treated appropriately.  The fracture was not able to be repaired due to the overwhelming infection so we did surgery to amputate his leg. A few hours after surgery he was up and loving on all of us.  He has recovered very well from surgery and has quickly become a staff favorite. He loves to give head butts and get belly rubs. He is Feline Leukemia Positive but that doesn’t stop him from being the sweetest boy ever.

Keuchly needs a loving Forever home – since he is Leukemia positive he needs to be an indoor kitty and ideally would go to a home with cats that are vaccinated against Leukemia. I know that once people meet this little guy they will fall in love and want to take him home. 

The Dreaded Cone of Shame

I'm gonna come right out and say it....I am Pro E-collar. Yes, that's right....I am all for the Cone of Shame. Some doctors lean more on the side of saying, 'let's give them a chance without it first'. Well, as a veterinarian and a mother of a two year old, I can tell you that animals and toddlers will do exactly what you don't want them to do as soon as you are not looking. Trust me!

Unlike you or I, our pets don't have the proper reasoning skills to know that they should not lick or scratch at their new incision or their sutures as they heal. Part of the healing process involves inflammation and that inflammation causes itching. When animals itch they want to scratch, or bite or lick or chew. Anything to get rid of the cause of the itching. Often that means the meticulously placed sutures or staples that are holding together poor Fido's belly or Fluffy's leg. Dogs and cats can undo our hard work in a matter or minutes. Just ask Carly's mom....Carly came to see us for a mass removal on her left forelimb. By all accounts, Carly is a great dog. She is an adult golden retriever and just wants to get as many belly rubs as possible. And she did great for her surgery - her incision closed up so nicely and she went home wagging her tail. Carly returned the next day - why you ask? In the matter of a few minutes when left unattended, Carly managed to pull out every single suture we placed in her leg. Unfortunately this meant another round of sedation for Carly and staples to close her incision. It also meant the dreaded (pause for effect here)................Cone of Shame.

I have heard all the excuses before...'he bumps into things', 'she is going to hate me for this', 'she can't eat/sleep/drink with it on'. I am here to tell you, the e-collar is harder on you as an owner than it is on your pet. Yes they bump into things on occasion and yes they may act like they hate you, but trust me they are fine. And isn't all that money you just invested in my surgical expertise worth having Fido wear her lampshade head wear for a week? A great surgeon friend of mine used to tell her clients to tape their invoice from their surgery to the fridge so that they could see it everyday to remind themselves why post-op instructions, such as e-collars, was so important.

It's a small thing and often declined by owners but it can prevent catastrophic infections and damage done by our pets. I support the Cone of Shame - consider it a fashion accessory for your precious pet!

PS - this is Carly....and the best news of all was that her lump was benign...No Cancer for Carly!

What's that itch?

Have you ever had an itch that you just can't seem to scratch? Ever have one deep down in your ear - in the part where you can't seem to get to it for any relief. Now imagine if the cause of that itch was hundreds of creepy, crawling bugs. Ear Mites....the struggle is real my friends. Luckily for us ear mites only affect our dog and cat friends.

We commonly see ear mites in pets that have been living outside or have been in shelters. They are easily transmitted from pet to pet. Dogs or cats that have ear mites will have very itchy ears with a characteristic black, coffee ground appearance to the debris in the ears. Nothing excites a doctor or technician more than the possibility of finding ear mites on a slide. It is so much fun to see them squirming around under the scope.

Luckily for us ear mites are pretty easy to treat - some products are available OTC (that's over the counter for you non-millenials) from your local pet supply store however their efficacy may not be as good as vet approved medications. Often we can treat ear mites with topical medications used for monthly heartworm prevention as the active ingredient works on these critters too.

If you think your pet has ear mites the best thing you can do is have your veterinarian examine him or her - other ear problems such as yeast and bacterial infections can look similar to ear mites. Only a cytology of the debris from the ears can tell the difference.

The next time you have an ear itch, be thankful this little guy isn't the culprit

It's just a little lump

We are taught in school that a lump is a lump and that ALL lumps should be tested (aspirated) for signs of cancer. I will admit that sometime between 2004 and 2016, I began to stray from that important piece of information. I think we all probably do this at some point - you start to take for granted the information that an aspirate of a mass can provide. We start to say things like 'oh this feels like a fatty mass' or 'this looks like it's just a benign mass'. But truly can we say that without doing an aspirate? The honest truth...no we can't.

Recently I saw a healthy 3 year old Great Dane on which the owner had noted a small (and compared to the rest of him this was small) lump on his tail. She said it had been there for awhile, maybe a few months, and had not caused any issues and did not seem to be bothering him.  At first glance the small lump, 1 cm in diameter or less, looked harmless. There was no redness, no irritation, there wasn't even hair missing around it. And the handsome boy certainly didn't seem to care if I touched it. I could hear myself start to say "this looks pretty harmless' but then I stopped myself. Was it harmless? How did I know that?  The truth was I didn't know that and I needed to find out.

So we aspirated it and I am so glad that we did. The sample I got from this small mass contained all the answers I needed to let his owner know what we needed to do next.

See those purple cells that look like they are exploding little purple confetti everywhere? My veterinary colleagues will know exactly what those are. Mast Cells. The dreaded imposter of all cancers.

Mast cell tumors are funny - they can lurk around for a while not causing any issues. They can look like small benign growths. They trick us into thinking they are harmless until they are so big and angry we kick ourselves for not aspirating them when they are just little mast cell babies. As I applauded myself (silently of course) for aspirating the mass I knew I had to go in and tell this dog's owner that this mass was cancerous. Because of its location on his tail we couldn't just remove the mass - we had to remove almost all of his beautiful long tail. Luckily his owner did not mind and wanted to do the best thing for him. So surgery was scheduled to remove this lump and the tail it came attached to.

After surgery we submitted the mass for biopsy - we already knew it was a mast cell tumor but these tumors like to be tricky. They can be low grade or high grade, infiltrative or well circumscribed, localized or metastatic. Luckily for this young dog and his family this particular mast cell tumor was a low grade and since we removed the tail there was no chance of it recurring at that location.

We will have to monitor him for future lumps.  Trust me every single lump on this dog will be aspirated from here on out. In day to day practice, sometimes its easy to fall into shortcuts  and every now and again its good to get a reminder of why they are important.

The reason why

Everyday as doctors we struggle between what we 'want' to do for our patients and what we 'can' do. Many people do not realize the limitations that we encounter during our day, often in the form of restrictions created by the owners of our patients. Often we are accused of not caring enough because we can't do procedures, diagnostics or even dispense medications for free or without an exam. Trust me when I say that if we could remove the monetary factor of veterinary medicine our jobs would be so much easier. We would no longer have to create a treatment plan that fits into a clients budget or pick and choose which diagnostics we think (ie hope) will give us the answers everyone desires. Too often we are forced to treat symptoms instead of diagnosing patients...which is what we all went to school for. As veterinarians we are problem solvers....we like to find out answers. We want to know what is causing the weight loss, the vomiting, the elevated liver values. Sure, if your dog is vomiting we can prescribe medications for that but we want to know WHY. And we want to know why because we do care. We know that the injection for nausea will help for a day or so but what if the reason your pet is vomiting is because it is in kidney failure. We care to find that out. We want to know if your cat is losing weight because it has cancer so that we can help ease its discomfort and give you quality time with him or her. We want to know that because we care. We care about the bond you have with your pet even when it seems that all we care about is making money. Discussing finances and cost of services generally makes us uncomfortable but it is a part of the job. Trying to put a price tag on a relationship with a family member is near impossible. Trying to put a price tag on my level of care, service and expertise is even harder.  The bottom line of it all is we do care - we care enough to try to do our best despite the limitations. We cut corners, we find a way, we come up with home remedies to try or we develop creative solutions to help our patients and their owners. Think about that the next time you visit your doctor - would they do the same?

Happy Monday Morning

Monday morning means different things to everyone....as an emergency vet it generally meant that a crazy weekend was coming to an end and I could go home and get some rest. To my daughter it means going back to school to see her friends. For most people it means the start of a new work week and potentially the beginning of stress headaches, bills and responsibilities. This morning it meant surgery. Lots and lots of surgery. We are lucky enough to have 5 full time doctors at our hospital which means we each get 1 day a week to do surgery. My day is Monday which means I start out my week doing the 'fun stuff'. A chance to cut is a chance to cure - or at least that is what all the surgeons taught us in school. I was definitely a problem-solver, internal medicine focused, type of student in vet school. In fact, post-graduation I went on to do additional training in equine internal medicine because I enjoyed the intense nature of these cases and it made me smile to see how many IV pumps I could connect to one single patient (if you have ever visited a very sick pet in an ICU you know what I mean). For those of us who preferred the challenge of electrolyte derangements and acid-base balances, we chose to say a chance to cut is a chance to kill. My time as an emergency doctor reignited my interest in surgery. The fact that I could see a dog come in with a GDV (bloated stomach...think "Marley and Me") and know that with proper surgical care I could fix that dog and send it back home made me look at surgery differently. Could it be that all those arrogant surgeons had it right all along? Was surgery more fun than medicine after all? It's all guts and glory after all - owners don't always recognize the time and brain power we put into carefully calculating exact fluid rates to bring down a dangerously high sodium level but they do appreciate that I can remove a bleeding spleen from their dog in under 60 minutes. Have I become a scalpel wielding, egocentric, master of the universe surgeon after all? Probably not but I do enjoy my time in the OR. Don't get me wrong...I still love the challenge of a good parvo puppy who needs a feeding tube and IV medications or a diabetic ketoacidotic who needs precisely titrated electrolyte and insulin infusions. But there is nothing better than starting your week off with a few good surgeries to get the blood pumping....bring on the spays, the declaws, the mass removals! My scalpel is ready :)

**disclaimer -some of my best friends are surgeons - no harm is meant by this blog**

This really did happen overnight....

I always laugh when clients give us the famous line ' this really did happen overnight' because often times it didn't. However....this literally did happen overnight....to my dog.

This is Duncan.....he is my 7 year old Boxer who I adore (sometimes) and find irritating at other times.....but truth be told he holds a special place in my heart. A few weeks ago my husband and I awoke to this. A big swollen faced boy. And that age old saying came out of my mouth...'this literally happened overnight'. Poor guy! His little nub of a tail still worked well and he eagerly greeted me at the bedroom door, butt wiggling, face all swollen from what I assume was an insect sting/bite that occurred sometime last evening or overnight. The poor guy looked miserable however he was still waiting to be fed! (Not much stops a boxer from eating!).

Luckily for Duncan his mom was prepared with some medications to relieve the itching and swelling. A few hours later he was back to his normal, sometimes irritating, self with a much more normal appearance.

Spring and summer seasons mean more outdoor play time for us and our four legged friends. I know I come inside with more mosquito bites than I can count and often our pets do as well. Not all insect bites will produce this type of reaction but if you do notice your pet is swollen or extremely itchy after being outdoors, a visit to the veterinarian is probably in order. It may be tempting to administer medication at home to help but we do recommend they be seen as well. Some insect bites/stings are more serious than others, for example spider bites can be extremely serious and lead to life threatening complications if not attended to by a doctor. Depending on the location of the bite and swelling it may be necessary for your pet to be monitored in hospital for a few hours. And some pets, like humans, can have anaphylactic reactions to insect bites which requires very intensive treatment.

So...if things do happen overnight and you awaken to a swollen face please give your vet a call. We love to help get them  back to their normal appearance

The ones left behind

It's 8 am and I am dropping my daughter off at daycare. I give her a big hug and say 'see you later' but the truth is it will be tomorrow morning before I see her again. As many other veterinary hospitals have realized, the traditional 9-5 hours just don't suit most of our clients anymore. More often than not veterinary clinics are extending hours or offering measures of convenience, such as drop offs or tele-medicine, to cater to the needs of today's busy clients. The truth is most people don't have the ability to drop everything and take their pet to the vet at 9 am on a Tuesday. And as veterinarians we get that....we are busy too. My days are full....even my days off are busy with appointments, housework, social visits, etc.  Honestly, veterinarians are people-pleasers. We want to be there when our clients need us, whether that be at 8 am or 8 pm. That in turn means we work longer hours than most people realize. Today, for example, I will work until 9 pm so that our clinic is available during those busy evening hours. We are available when our clients get home from work and discover that Fluffy has vomited several times, Squeakers has come home from his adventures and is limping or Max has started seizing for the first time. We are there to provide care with a  friendly face and a smile so that our clients don't have to go to a clinic where they don't know anyone. We are there. And at home we leave behind our families and our pets to be seen by us another day. I don't often give my husband and daughter enough credit. My husband was with me when I worked as an  emergency vet and was gone for 14 hours at a time. He stayed with  me when he didn't see me for 5 days in a row...when we were merely ships passing in the night. I sacrificed being at home during the first years of our marriage and over holidays because I truly love what I do and the people I do it for. I want to be there when you need me the most. It pulls at my heart strings to not see my daughter for 24 hours but I know my clients appreciate my sacrifice to be there for them and their four legged children. And I want to set a good example for my daughter - that being dedicated to your career is a good thing. That hard work pays off. That if you do good for others, good things will happen to you. So the next time you bring your pet in at 8 pm for an appointment remember to thank your veterinarian for their sacrifice. Those left behind at home  hope you appreciate what we do.

How hard could it be....isn't it just puppies and kittens?

Ask any veterinarian and they will tell you that they have heard this question at least once in their career. The truth is more often than not, our days are not full of happy puppies and kittens. Most of our daily appointments are filled with aging patients, sick patients, even dying patients. At this point in my career, the happy puppy and kitten visits are few and far between, providing a much needed respite from long talks with owners about quality of life or pricey diagnostics needed to determine what is ailing their furry family member. I recently had the pleasure of seeing a dear friend of mine's new puppy. A 5 month old Labradoodle.....cute as a button  as you can imagine. It was not very long ago that I helped this same friend say goodbye to two very beloved pets who had been with her for longer than I can remember. It was my honor to help her end their suffering just as it was my honor to help her bring in a new family member. This loving bundle of chocolate colored fluff would bring joy to a family that so desperately needed it and I was glad to take an hour of my day to spend with her as we discussed Miller's preventative care plan, his diet, his exercise and his overall health. As Miller lay at his new parent's feet I knew that this dog would be loved more than any other dog could imagine and I also knew he would be filling a hole in the hearts of two people who had  so much love to give. It's these days, the few and far between, that remind me why I became a veterinarian. So yes...sometimes it is just puppies and kittens...if you are lucky.