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**