10.31.2016 Emergency, South Bay, CA

Case Count: 21

Happy Halloween! Please be safe. Please don't let your pets get into chocolate. Let's agree not to spend at least two hours and $400 handling that situation. 

That said, I am absolutely here to save the day if needed.

Case of the Day

1yo female spayed Yorkie mix
Chocolate ingestion...plus
     This happy little dog ate a small amount of milk chocolate Halloween candy. Not a lot, low risk. Her owners brought her in for decontamination to be on the safe side. No good deed goes unpunished, though. When we made her puke, we found a raisin, which is only problematic in a small number of dogs, but can cause life-threatening kidney failure in those few. Any exposure is an automatic recommendation for two days of hospitalization, fluids, labwork, and other jazz. Bummer, right?

     The owners elected more conservative outpatient treatment and will check in with their vet for recheck labwork tomorrow and the next day. SUCH A CUTE PUPPY.

11.3.2016 Emergency, South Bay, CA

Case Count: 

I got a burst of energy this week when I should have been day-sleeping to recover form a string of night shifts. I decided to start working on a dog crate to put in the corner of the new apartment. The idea was to provide more real estate for Heather's plants (our plants, but she has the green thumb and does all the work, so, you know) and also a space-saving dog bed solution. I used some lumber left over from the headboard of an Ikea bed frame...

Let me back up. I built a platform bed and headboard a couple years ago, but the platform was too big for the new bedroom, so we dismantled it and used the rails as shelves throughout the new apartment. We then bought a cheap Ikea bed frame and attached it to the headboard. Now we're caught up. I wanted to make Heather a platform for her plants in the kitchen, and create a nook for the vacuum and cleaning stuff, and reduce the footprint of our dog-encasing apparatus. 

With that in mind - my wired, sleep-deprived mind - I improvised my way through the project. I'm really pleased with how intentional it came out. Final result is below. 

Also below was my original plan to train my cats out of climbing on the countertops. The long strips of tape were less deterrent than I expected, so I tried loose pieces of tape sticky-side-up instead. It was hilarious, and promising. My cats are nothing if not intrepid, though, so I think it will be a battle of wills before the behavior goes away completely <unrealistic wishful thinking font>. I am smarter than my cats, I am smarter than my cats, I am smarter than my cats...

Favorite Quotes

  • "No need to apologize, I'm not offended by what you're saying about me, I'm just pointing out that you're incorrect."

Case of the Day

6yo male neutered Pitbull
Chronic recurrent corneal ulcers
     The cornea is the clear surface of the eye that lets light in. It's made up of several layers, and sometimes those layers get cuts or ulcers from all kinds of causes, ranging from direct trauma (cat scratch, tennis ball), to foreign bodies (splinters, thorns), to infections (herpes or calici-virus in cats, bacetria), to dry-eye (immune system mistakes tear glands for invaders and attacks them). Corneal ulcers hurt like crazy, so most cases present with squinting, facial rubbing, redness, and swelling. Sometimes there's tons of mucus, even pus.

Another common sign is cloudiness, which many people mistake for cataracts, except cataracts occur in the lens rather than the cornea. Both structures are transparent because the collagen and other fibers are precisely aligned. When water invades the space (because of inflammation or another process), the fibers get forced out of alignment and light bounces around inside the layer rather than passing straight through it. We see that as cloudiness.

This dog, who belongs to one of my coworkers, has had multiple bouts of corneal ulceration in both eyes lasting two or more weeks at a time. Your uncomplicated ulcer should heal within 7 days, period. If it doesn't, one of a small number of things is happening: infection, continued trauma, indolent ulcer (separation of the layers like fluttering pages in a book), or dry-eye. In this case, i'm suspicious of a condition called entropion, where the eyelids roll inward and the haired skin rubs against the cornea with each blink. Partly, this is because one of my colleagues ruled out a bunch of other causes during the last episode. I'm no expert, though, so I'm recommending the pooch see an ophthalmologist.

In the meantime, my coworker will add serum to the antibacterial eye drops he's been using. By serum, I mean we literally draw some blood from the patient, spin it down to separate the clear part of the blood (serum) from the red part (red blood cells). Then we apply the serum to the eye like eye drops. The serum contains all the healing factors and other junk your bloodstream carries that help wounds heal, but since the cornea has no blood vessels (otherwise they'd look red instead of clear), they don't typically have access to those tools. Further treatments can include sewing the eye shut for a spell (see my tarsorrhaphy post from 10.28.2016), debriding (forcibly removing) the edges of the ulcer to promote a healing response, or temporarily sewing a piece of the conjunctiva (the pink part surrounding the eye) to the ulcer so it's exposed to the bloodstream directly. 

Of course, that doesn't solve the underlying problem...why does this keep happening. If it's entropion, we treat that by removing a crescent-shaped section of the offending eyelid(s) to roll it(them) away from the cornea. Yes, a lid-lift. A medically necessary one. 

Sorry I don't have great pictures, I'll try!

10.29.2016 Emergency, South Bay, CA

NOTE: Wound repair description and pics in "Case of the Day" section

Case Count: 5

Emergency practice is not ALWAYS serious business.

This is the first week Heather and I have been on opposite schedules. It sucks. She started a real 9-5 tech job that's crazy fascinating (ask her, it boggles my mind), which I'm so proud of and so excited about....BUT....now I miss my woman all the time. I got lots of stuff done around the house, though :( 

I had a really fun time talking vet school shenanigans with one of my colleagues who graduated 35 years ago. My my, how much more...permissive...the education system was. Sorry, no details to share. We're professionals. I swear. 

Case of the Day

13yo male neutered Shepherd mix
Laceration
     This elderly gent sat on an outdoor lawn light fixture. A glass one. Being about a hundred pounds, the dog won, but the fixture got its revenge in the form of a deep laceration on the back of the dog's leg. This was complicated by the fact that he had severe arthritis and wears a harness for assistance rising and walking. Even under the best of circumstances, he resents the pokes and prods of veterinarians, which I completely respect, but which was made all the worse by pain and stress. We gave him some good pain management and I was surprised to find only the single laceration, which closed up nicely. I was expecting a bit more "hamburger". It's a technical term. Use your imagination. Pain meds, antibiotics, e-collar, stitches out in 2 weeks.

     This was a serendipitous event - really, hear me out! - because I was able to confirm his kidneys and liver were healthy enough to start anti-inflammatory meds that can be continued for arthritis after the cut heals up. Might have just raised that dog's quality of life for good!

10.28.2016 Emergency, South Bay, CA

Case Count: 6

Coworker

Four shifts in a row is tough. Four shifts in a row over Halloween weekend could get VERY rough. So far, so good, though. No meth cases yet <yay face>. Unfortunately, though, I did have two euthanasias <sad face>. On a happier note, my coworker's mother brought some leftovers from an office pot-luck <tamale face>.

Go watch the show Look Around You. You'll thank me. Don't learn anything about it ahead of time. 

Coworkers

Favorite Quotes

  • "Thanks, ants. Thants."
  • "If you've ever written with a calcium nib, or looked through a calcium lens, it probably came from Holland."
  • "Helvetica Scenario."

Case of the Day

1-month-old female intact Terrier mix
THC intoxication
     Tiny little dog got into some pot. She ended up fine. Cutie-patootie. 

10.23.2016 Emergency, South Bay, CA

Case Count: 7

READ TO THE END...

Nice drop in pace, but a very eventful shift nonetheless. The cutest case(s) was/were two poofy lap dogs who got into some chocolate truffles while their owners were away. At least, it was assumed they both did it, because "they share everything." Really cute dogs who did not appreciate being made to vomit. Wrappers and fragrant chocolate puke from both. Two more lives saved

Favorite Quotes

  • "Yes, if you're unable to stop the bleeding, then you should come in now rather than wait until your regular vet opens tomorrow."

Case of the Day

3yo male IntactYorkie/Chihuahua mix
Multiple drug intoxication
     I suspected this was another meth case when I walked in the room and the dog was repetitively stretching his neck and then spinning in a circle. I was right...but that's not all. Somehow, this tiny dog got into enough meth, cocaine, oxycontin, and THC to test positive and still survive. The meth effects were most obvious and longest-lasting. Oxycontin usually wears off in around 8-12 hours, THC in 12-24, meth can take longer. Two meth cases in 24 hours...what a weekend.

Moving so fast, every picture was blurry.

10.22.2016 Emergency, South Bay, CA

NOTE: Eye-related injury + surgical pictures in this post

Case Count: 15

Holy intensity. Heads up, this was a gory shift. I got a bunch of cases of all different types one right after another. Uncommon problems, too. The first case of the night was a terrier that had darted into the street and got hit by a car. The skin on his chest, neck, and face was peeled back in one large flap and his right eye was proptosed (bulged out of the socket). We put him to sleep right away. One elderly white Shepherd came in breathing abnormally and probably has a fungal infection in his chest and lungs, confirmatory test is pending. A little friendly Yorkie escaped from his house the day before, was purchased by someone who then saw the lost/found signs and returned him (for a profit). When the owner bought his dog back, the poor little guy was severely restless and agitated...tested positive for methamphetamine. A tiny white dog presented with heart failure, and he had no teeth, so his grey/blue tongue lolled out the side while he heaved to catch a breath. That little guy took a while to improve, but did okay. 

Favorite Quotes

  • "No need to apologize, I'm not offended by what you're saying about me, I'm just pointing out that you're incorrect."

Case of the Day

10yo female spayed mixed-breed dog
Proptosis (prop-TOSE-iss), AKA "eye popped out"
     After midnight, a couple returned home from a party to find their terrier with a proptosed right eye and a laceration on the left face, likely the victim of a bite from the powerful jaws of a larger dog that bit hard enough to pop the right eye out. We replaced it and sewed the eyelids shut, a procedure called a temporary tarsorrhaphy. The plan is to leave the sutures in for a week to let the inflammation and possible behind-the-eye blood clot to go down. Sometimes that's all that's needed, other times the tarsorrhaphy gets placed againi for a longer duration, and other times we end up needing to remove the eye anyway. It's uncommon for the eye to function visually after this injury, but it can stay as long as it's in the right place and is nonpainful. Obviously pain meds, antibiotics, and an e-collar until resolved one way or the other. 

10.30.2016 Emergency, South Bay, CA

Case Count: 21

My first shift at the brand-new location in Mountain View! Sharp-lookin' place, I must say. There are a couple of minor to-do items and I couldn't help a couple of snarky pictures, it's just my nature :) The leash hooks are malfunctioning...

I'm bummed to be working Halloween. I will always treasure living on D Street in Petaluma, it was the only place I ever got to hand out Halloween candy. It was one of those streets where everyone goes all out and it got crazy crowded. I used to put my kitties in a spooky cage and buy roughly $1400 of candy to pass out. Kids loved petting the cats, who were dressed as vampires. One year, I wore my Batman mask - well, one of them - and my homemade cape. It's not a Batman cape, it's a Super D cape I made, because I'm adult and I get to create my own character and make myself a logo and put it on a shiny silk cape. I wore these with street clothes, which I don't mention to brag (ladies...), but to highlight how AMAZING it felt when a little girl came around the corner, looked up at me with huge surprised eyes, and said, "Mom...that's...the real...Batman." She was super impressed. And it felt awesome. I love this holiday.

Favorite Quotes

  • "How's THAT for a Vagina Monologue."

Case of the Day

13yo male neutered Cavalier King Charles
Pancreatitis
     This dog came in for vomiting eight times and straining to defecate without producing anything over the past two hours. He had a history of chronic heart disease (CKC's are predisposed to heart valve disease) and splenic disease. No known inciting event for the vomiting (toxins, trauma, wildlife exposure, other sick pets, travel, known foreign object ingestion or dietary indiscretion). On physical exam, he had severe abdominal pain - I'd touch his belly and he'd arch his back, whine, and tense his belly really hard. He had a very loud heart murmur and he was breathing rapidly, but his lungs sounded okay. Rectal exam showed an empty colon with mucus on the glove.  He had the standard dental disease and CKC facial abnormalities (bulging eyes, crowded teeth, etc). 

     The two big problems that jumped to mind were pancreatitis and a GI foreign object. Lots of other things could be going on, but it was important to rule out a surgical disease and a disease requiring aggressive treatment. The owner approved a blood test that confirmed pancreatitis, though that can develop secondary to a number of other problems, so xrays were still needed. Xrays showed some highly visible abnormalities, including mineralization throughout the liver and an abdominal mass. The liver mineralization isn't automatically concerning, it can happen as a benign age-related change, but it looks like it SHOULD be scary, you know?

     The owner elected symptomatic outpatient treatment, so we gave injections of pain meds, anti-nausea meds, antacid, fluids under the skin, GI motility stimulator, B-vitamins, broad-spectrum antibiotic, and a prescription of GI-specific antibiotic. Due to check in with the primary vet in the morning for likely continued inpatient care.

10.18.2016 Emergency, South Bay, CA

Case Count: 21

This is the first week Heather and I have been on opposite schedules. It sucks. She started a real 9-5 tech job that's crazy fascinating (ask her, it boggles my mind), which I'm so proud of and so excited about....BUT....now I miss my woman all the time. I got lots of stuff done around the house, though :( 

Favorite Quotes

  • "No need to apologize, I'm not offended by what you're saying about me, I'm just pointing out that you're incorrect."

Cases of the Day

10yo female spayed mixed-breed dog
Brain tumor
     This was actually the Neurologist's case, but I handled the overnight recovery, so I get to mention it to you folks. This dog presented the week before for seizures. Imaging showed a tumor on the front of the brain, which in dogs is dominated by the olfactory lobe (processes scent). Dogs dedicate a similar amount of their brain to scent as humans do to sight. This tumor was about 20% as big as the brain, which in this dog was roughly the size of an apple. The most common type of brain tumor in dogs is a meningioma, a benign tumor that grows between the brain and the skull, meaning that surgery is successful more often than one would think. Most owners don't have a ton of money or pet insurance, so even the treatable cases tend to get euthanized when the owner's can't sign up for $7,000-10,000. This dog had surgery, which involved cutting out a piece of the skull in the middle of her forehead like the top of a pumpkin, [carefully] scooping out the tumor, then replacing the bone with a couple of tubes to allow ventilation during healing. The Neurologist had to access the brain through the frontal sinus, which is an empty space between the forehead bone and the bone surrounding the brain. The sinus is continuous with the nasal passage, which is important because without the tubes for ventilation, a simple sneeze could have blown a bunch of air into and around the brain. The risk of placing the tubes, of course, is that they might...you know...poke the brain. Even with a gaping cavity where the tumor used to be. This dog recovered smoothly and went home. Best case scenario is no more seizures, uncomplicated bone/incision healing, slow regrowth of the tumor. Fingers crossed!

10.17.2016 Emergency, South Bay, CA

Case Count: 11 (Euthanasia Count: 5, DOA Count: 1)

"The pink juice"

Long shift, got slammed in the evening hours. I played Dr. Euthanasia a lot...five very involved cases sprinkled throughout the shift. Sad day. I went to the lobby to grab enough coffee to fortify me for the drive home, and there was a gentleman sitting with his seated, perky Cavalier King Charles. He'd come in while I was busy with two early-morning cases that both turned into deaths.

"You do those euthanasias?" he asked me.

"I do. Five of them tonight."

The man shook his head and I could see memories flit across his face. "I had to put down two of my dogs. I don't ever want to do it again, though I know I'll have to. I don't know how you do your job. I wouldn't do it."

I hear some variation of that often, but this time it hit home. It felt nice to be appreciated, for someone outside my experience to acknowledge the demands of my work. I started with my standard reply, "I only do it when I know it's my best medicine," but I added, "Thank you for understanding. It means a lot. Have a great day."

On a side note, I avoided a crummy situation with my last case, an old Beagle with rear leg paralysis (probably spinal disc problem). Sometimes pets will have involuntary muscle contractions (twitching) or big breaths after death (agonal breathing). Even when it happens as part of death, they don't experience any pain or stress because the euthanasia solution is an overdose of anesthesia - they're completely unconscious well before they die. I try to caution people about this possibility beforehand, but that doesn't always happen, either by circumstance or oversight. 

When people aren't expecting it, these can be extremely distressing and sometimes they make people doubt that the pet is dead. Today, I confirmed absent heart beat, pulses, breathing, and neurologic function in my last patient and left the room for the owners to visit with his remains. When I checked back in, they mentioned that he'd "Started moving." I confirmed death once again to make sure we were all on the same page, and then his chest heaved reflexively, making a snorting sound through his floppy lips and throat. I braced for the owners' reactions. 

"He sounds just like he does when he snores!" they said with a tearful laugh.

Not the worst outcome.

Cases of the Day

1yo female Spayed Domestic Shorthair cat (DSH)
Ingested part of a toy
     This cat was playing with a dangling cat toy with her owners, when she succeeded in breaking the string and making off with the plastic bobber attached to about three inches of string. Her owners chased her around the house and just as they cornered her, she swallowed the whole thing. We tried to get the cat to puke, but our puke-meds don't work as reliably in cats as they do in dogs, and she maintained possession of the toy. This is a difficult decision. Do you a) go straight to endoscopy, where we anesthetize and hunt in the stomach with a camera to avoid surgery, or b) give it time, some symptomatic care and hairball treatment and see what develops. With option "a", we might pull the thing out without surgery, but run the slight risk of anesthesia/scope complications, mild risk of not being able to remove the object for a variety of reasons, and definitive risk of a couple thousand dollars minimum. With option "b", we might get away with it, or we might end up in surgery to take the thing out of the intestines. Also more dollars. I've been burned in both directions and I can name three other "a" docs and three other "b" docs off the top of my head. The owners at first wanted to scope, then decided to wait it out. While they were consulting, I tried another dose of puke-meds and...success! Went home for a couple hundred bucks, no longterm risk. Happy day. Except for all the euthanasias :(

10.13.2016 Emergency, South bay, CA

Case Count: 3

Back to the grind. The move-in is finally complete! Midway through unpacking, we lamented the apparent lack of progress to one of Heather's friends who cheerfully chirped, "No worries! Moving always looks worse and worse and worse and then suddenly you're done!" Totally accurate. We put up the last of our wall-hangings (some street-art I got when I lived in Amsterdam), and the place just snapped into focus. There are tweaks to be made, but we have a home. Warm.

Cases of the Day

Geriatric Yellow Lab
Status epilepticus
     Last thing after a slow night, just about to start locking up, a gentleman brought in his dog that had been actively seizuring for at least an hour. The dog reportedly had been on anti-seizure medications for several years with seizures every few months, then every few weeks, then every few days, then many a day over the past few days. There was reportedly much discussion in the household about when to euthanize, but we were able to do so right away and let this poor guy rest. The good news from a suffering standpoint is that during a generalized, or gan mal, seizure, disorganized electrical impulses flood the entire brain and cause a complete lack of consciousness. An hour-long seizure is difficult to come back from, and the history of increasing seizures in the face of treatment made euthanasia the very clear and immediate option. This is one of those moments where I know that euthanasia is my best medicine, that I did good, that, despite the sadness, I helped.  

10.9.2016 Emergency, South Bay, CA

Case Count: 21

I still get startled by the intensity of my emotions after a busy emergency shift. I tend to have a predictable physical and emotional pattern on those days. Last night was an example:

I was stressed out by cases coming through the door up until about a half hour before shift-change, when my focus shifted to tying up all my loose ends before transferring care to my overnight colleague. When we finished rounding, I had a surge of energy and positivity, an emotional weightless feeling looking ahead to a few hours of shaking off the responsibility of caring for patients. My mind raced pleasantly, I felt energetic and good. About ten minutes into my commute, I could physically feel my mind and body sliding down to the bottom of a hill as exhaustion pulled the ground out from under me. Within a half hour, I was barely awake and felt irritable and...the only way I can describe it is that I felt like I was in a small dark room that had only annoying things outside the door, though I was too apathetic to get up and confirm. 

It was a twelve-hour shift with another this morning, so I had about an hour to visit with my Love, taste the first batch of cookies she mixed using her new Kitchenaid mixer, stuff some food in me, shower, and get to sleep. Showers are emotionally rejuvenating for me.  Maybe it's something about cleansing myself of the day. In any case, the emotional burnout and need for a quiet mind make me understand why folks reach for chemicals or destructive behavior to switch off. To get to a place of calm RIGHT NOW. 

It's a lot. This job takes a lot out of me. I'm better adjusted than I was even a few months ago, owing to an amazing partner, good mental health choices, and a (finally) dialed-in brain medication regimen.

Favorite Quotes

  • "Okay, Doctor, thank you, I wanted to talk to you because you gave me peace of mind yesterday." 

Cases of the Day

7yo male neutered Cockapoo
Keratoconjunctivitis Sicca (KCS)
     Kerato = cornea = surface of the eye. Conjunctiva = the delicate pink tissue under the eyelids. -itis = inflammation. Sicca = dry. KCS = Dry Eye. Most often, caused by the immune system attacking the tear glands. Without tears, the eye dries out, becomes painful, can become infected, and can lose its clarity. This dog came in with mostly-closed eyes from squinting and lots of gunky material in/around his eyes. Signs present for 7 days...so painful. Luckily, no apparent damage to the cornea, so should heal up with eye drops that suppress the immune response (cyclosporine). Interestingly, the same drug is used in pill form to treat skin allergies in dogs and is given to human transplant patients to lower the risk of immune-rejection of the new organ. To continue the etymology geek-out, the brand name of cyclosporine for skin allergies is "Atopica," because it treats "atopic dermatitis." Atopic = no skin. Derm- = skin. -itis = inflammation. Atopic dermatitis = No skin skin inflammation. It refers to the fact that the skin fails to perform its barrier function, allowing pollen/dust/mold/airborne particles to penetrate and trigger the immune system. Fascinating stuff. 

10.7.2016 Emergency, South Bay, CA

Case Count: 12

While it sucks to go back to work after a week of moving, it's nice to not be actively moving after a week of moving. I LOVE being closer, though. Getting to go home with enough energy not to simply fall into bed is a real treat. Plus we have a kitchen again and heather makes bangin' lunches. Yummy spinach salad today.

Also, laceration repair!

Favorite Quotes

  • "We need to start a phone tree for everyone here who lives in the East Bay. 'It doesn't matter when you need to get to work, traffic is effed up, you got to leave NOW'."

Cases of the Day

15yo male intact Pitbull cross
Unable to walk, foul odor, dermatitis
     This case was a perfect example of why it's important not to make assumptions. From a distance, this dog appears similar to a neglected case. Even the history of "she looked much better a week ago" doesn't in itself dispel that possibility, because I've had many cases of clearly long-standing illness that owners either genuinely didn't notice or are being untruthful about. In this case, I got the sense that this dog has had a genuine decline over the past 7 days. Also, the owner put up several thousand dollars happily to diagnose and treat what we could, knowing that we may ultimately have to euthanize due to poor quality of life. My hope is that this sweet older gent dog has a nasty arthritis flare-up and has developed some skin and urinary problems secondary to being unable to walk around. I've seen patients, especially older patients, deteriorate catastrophically with no obvious bad disease within days. That's how I want to go - long life with a rapid drop-off at the end. 

10.6.2016 Emergency, South Bay, CA

Case Count: 8

I'm finally moved to Oakland! I LOVE my new neighborhood in the Laurel District - diverse, friendly, genuine community. Heather and I have gotten nearly completely unpacked, and the place is looking more and more like a home. We've made serious dents in our NSAID supply, due in no small part to a nasty back misalignment (subluxation of the left T4 facet) I developed installing a custom bookcase. Carrying that 250lb concrete table top to the second floor was also not awesome. 

 

Favorite Quotes

  • As I join five other people in the reception area - "I just though this space needed another person."
  • "I told him to get a picture of me and Selma Hayek, but he didn't recognize her and thought she was just some cousin of mine or something. In Paris." 

Case of the Day

11yo female spayed Shih Tzu
Congestive Heart Failure (CHF)
     When the left side of the heart fails to pump blood forward well, it gets backed up (congested) in the lungs. The increased blood pressure forces fluid into the lungs, which blocks oxygen absorption. This dog was breathing rapidly and with major effort to compensate, which is typical in late-stage failure. Other signs can include coughing, collapse, turning blue, and even death. Signs usually come on over time (days, weeks, months), but can develop suddenly. This little dog has a housemate that's got bad cancer, and the family lost a human member last year. She has recovered and will go home on meds, but we can't predict how rapidly the CHF will worsen. Very sweet owner, I enjoyed the opportunity to learn about her family and explain the mechanism and expectations for this disease. 

9.28.2016 Emergency, South Bay, CA

Case Count: 7

Have I mentioned how much I hate mornings? I hate them intensely. He says with sagging eyelids...

The move is really happening. Tomorrow my apartment will be packed up, and the next day I'll be living in a different city. Strange how life happens seemingly TO you. Yeah, I made the decisions, but jeepers, life is shifty.

Favorite Quotes

  • "Okay, Doctor, thank you, I wanted to talk to you because you gave me peace of mind yesterday." 

Cases of the Day

7yo male neutered Cockapoo
Keratoconjunctivitis Sicca (KCS)
     Kerato = cornea = surface of the eye. Conjunctiva = the delicate pink tissue under the eyelids. -itis = inflammation. Sicca = dry. KCS = Dry Eye. Most often, caused by the immune system attacking the tear glands. Without tears, the eye dries out, becomes painful, can become infected, and can lose its clarity. This dog came in with mostly-closed eyes from squinting and lots of gunky material in/around his eyes. Signs present for 7 days...so painful. Luckily, no apparent damage to the cornea, so should heal up with eye drops that suppress the immune response (cyclosporine). Interestingly, the same drug is used in pill form to treat skin allergies in dogs and is given to human transplant patients to lower the risk of immune-rejection of the new organ. To continue the etymology geek-out, the brand name of cyclosporine for skin allergies is "Atopica," because it treats "atopic dermatitis." Atopic = no skin. Derm- = skin. -itis = inflammation. Atopic dermatitis = No skin skin inflammation. It refers to the fact that the skin fails to perform its barrier function, allowing pollen/dust/mold/airborne particles to penetrate and trigger the immune system. Fascinating stuff. 

9.27.2016 Emergency, South Bay, CA

Case Count: 7

I still hate mornings. This was in no way improved by getting caught in the middle of a couple first-thing-in-the-morning communication errors beyond my control.  

There's a big fire raging in the Santa Cruz mountains, and it dominated the skyline on my way home from work. Reminds me of the Oakland Fire that claimed my childhood home in 1991. The smoke was ironically beautiful in the evening sun. 

All rights reserved by DerekThevet.com

Had a smoke-inhalation and a near-drowning patient today (one of each). Those aren't all that common.

Favorite Quotes

  • "We were discussing words that don't mean quite what you think they mean and Google is telling me I'm full of shit." 
  • "Thank God for Derek!" "Somebody heard you say that, right? Did someone hear her say that? I need a witness."

Cases of the Day

6-month-old female intact Terrier mix
Traumatic brain injury
     Went home subdued and reluctant to eat without coaxing, but otherwise doing great!

6yo male neutered Shepherd mix
Grape ingestion
     Most dogs do just fine with grapes, but every once in a while, even a single raisin/grape can cause life-threatening kidney failure. So a lunch turned into a recommendation for 3 days of hospitalization and supportive care just in case. Luckily, this dog had been previously exposed with no problems, so the risk is low. Made the dog puke 'em up, gave fluids, gave activated charcoal (messy), and sent home. DELIGHTFUL Italian gentleman owner. So lovely. 

 

9.26.16 Emergency, South Bay, CA

Case Count: 10

I hate mornings. That is all. 

Favorite Quotes

Shared with permission. All rights reserved by DerekTheVet.com

  • "Anyone gonna watch the debate?" <retching sounds>

Case of the Day

6-month-old female intact Terrier mix
Traumatic brain injury
     Head trauma from a truck. 5-pound dog. She came in unconscious on my colleague's shift and has improved far more and more quickly than expected. Her owner is a delightful woman who's raising a severely autistic adopted daughter from China. Unfortunately, her daughter and six other autistic kids and their parents were having a picnic outside when the dog ran into the street and got hit. Based on her experience, she was not nearly as upset about the uncertainty of her dog's neurologic future as other owners have been in my experience with TBI's. We will continue supportive care and pain meds while we wait to see what comes back online over the next days and weeks. 

9.23.2016 Emergency, South Bay, CA

Case Count: 10

Back at work after two weeks off. Had a great trip to Vancouver and am NOT in the mood for an early morning. I hate mornings. I hate mornings more than I can communicate. I'd say more than I can articulate, but I couldn't even express it through interpretive dance - I hate mornings.  

In other news, I have a new baby niece, who I met yesterday. Also, I'll be moving back to Oakland this month. VERY EXCITING TIMES. 

Favorite Quotes

  • "Good morning!" "That's an oxymoron."

Case of the Day

7yo female spayed Chihuahua
Penetrating wound to right eye
     This poor little Chihuahua ran directly into a piece of garden wire that the owner had to pull out of her face. The owner was unable to see what was injured initially, but upon presentation, the right eye was bulging most of the way out of its socket and had bloody tears. Luckily, the globe was still behind the eyelids, and there appeared only to be surface damage. I suspect the wire penetrated just to the side of the eye and caused bleeding that pushed the globe outward. Sometimes we have to replace the globe behind the lids, sew the eyelids shut, or even remove the globe (enucleation), but this time we got away with pain meds, antibiotics, and a plastic cone-of-shame. The dog was so sweet and affectionate throughout handling, even before pain meds. Time will tell as the swelling subsides whether there was permanent damage to sight, ocular muscles (causing a lazy eye), or whether the globe will settle back into position without surgery. We try to avoid taking a globe out unless it's painful or causing other problems, even if it's blind or doesn't work right. 

9.11.2016 Emergency, South Bay, CA

*MIGRAINE ALERT 5pm

Case Count: 4

I hope today everyone finds connection. I appreciate loving and being loved by my family and friends. I'm grateful I'm alive and in a position to help people and animals. I hope to enrich the world the lives I get to share, even if briefly. 

Favorite Quotes

  • "I'm lucky, my lady takes good care of me. I don't deserve it." "None of us do."
  • "ANOTHER squirrel?" "'Tis the season."
  • "A Monoject 412." "A what?" A Monoject 412." "A what?" "Curve tip." "Oh. I've never heard anyone call it that." "I'm the only one, I forget."

Case of the Day

18yo female spayed Domestic Shorthair (DSH) cat
Recurrent UTI
     I had a rewarding conversation with a couple of owners today about their cat's suspected UTI. The particulars were convoluted and it took some serious interviewing to get a clear picture of the case. Once that was done, we had a good long chat about what might be going on, how we could find out what's going on, and how to proceed with treatment. It was one of those scenarios where the way forward could take several branches, and there isn't a clear "right" answer. The owners and I had to communicate clearly and articulate priorities to figure out the best plan for this pet at this moment. It felt amazing to see the spark of understanding on their faces, and to feel the team-building in a single conversation. They came to understand their cat's disease better, and, more importantly, had clear expectations about what could happen and how to respond appropriately. We came out of the room moving in the same direction and feeling on solid ground. Really proud of that.

9.10.2016 Emergency, South Bay, CA

Case Count: 8

Man, oh, man. I'm feeling untethered from time, it feels like I'm here or driving to or from here every minute of every day. Eight shifts in nine-and-a-half days. It's even weirder when it's quiet, which it was most of today. I had a flurry of cases in the evening, though. 

I was really bummed out by a young squirrel that got munched over the pelvis by a cat and has one leg that's not working. Hopefully it's temporary. I gave him the tiniest doses of pain meds, antibiotics, and fluids. He perked up, but...I'm skeptical that he'll recover. Also had a hospitalized bunny, a dog that may have eaten a rat (left without diagnostics or treatment), a raisin ingestion (can kill some dogs' kidneys), another sqirrel in a comically over-sized box, and a dog with a sore dewclaw (for a month). 

Injured squirrel

Overly-contained squirrel

Oh, and a little white dog that took a car to the shoulder and seems only to have a sore shoulder (on account of THE CAR)...and high liver enzymes that I'm still trying to explain.

Oh, and the Animal Control Officer had a giant tortoise in her van. Because he was, like, wandering around. A neighborhood. WTF?

Favorite Quotes

  • "Today is Day 3 of 4?" "I'm looking at it more as Day 7 of 8."
  • Phone rings after we discharge a squirrel to Animal Control - "Another squirrel." "ANOTHER squirrel?" "Another squirrel."

Case of the Day

9yo female spayed Bernese Mountain Dog
Bone cancer, euthanasia
     Bone cancers are most common in large- and giant-breed dogs, and the most concerning type is osteosarcoma. This cancer is extremely aggressive and painful, mostly occurs in the limbs. This dog started limping a month ago and stopped being able to use the leg this week. By yesterday, much of her femur was visibly eaten away on xrays. The most effective pain relief, believe it or not, is to amputate the affected leg. Osteosarcoma spreads so fast, though that patients still die, often before they've fully healed up from surgery. There are cutting-edge limb-sparing surgeries and chemotherapy/radiation can help extend life for weeks to months, but most owners end up euthanizing without extensive workup and treatment.

The owners had us collect a bunch of samples (cheek swab, blood, and tumor) to submit for a Bernese Mountain Dog DNA/Health database at Michigan State University, so she helped move us along in our understanding of this devastating disease. They also brought in their other Berner for the appointment, and she was a supportive champ through the whole thing. One of the owners said this was his first dog. He was extremely upset. I hope I was able to communicate through their grief that this was a compassionate and well-timed decision.