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!