Tuesday, January 26, 2010

Saving Dot

Today, I had some unexpected free time that is just perfect for writing my weekly blog. Usually I start looking for my next topic as soon as the previous week's blog is done. If possible, I try to use a recent case at the clinic for inspiration. Weekends are good for taking my dogs for long walks and thinking of blog topics. Funny how long walks are good for thinking. Unfortunately I spent most of the weekend attending to my dinosaur of a computer at home so when this free time fell into my lap, I was literally without an idea. Fortunately Ashley, one of my vet assistants, came to my rescue when she said "Blog about Dot!". Perfect! I know Ashley liked the idea because Dot is a cute dog with a feel-good story that has a happy ending. I liked the idea because I get to brag about the staff at The Country Doctor which, if I haven't said it before, is the best staff on the planet.

Dot is a year and a half old beagle whose story starts the week before Christmas 2009. She snuck out of the house and went missing. She was found laying in a nearby field and was unable to walk. Her owner brought her to the clinic. Dot had a lot of road rash, a broken pelvis and a broken right front foot and it became quite obvious she had been hit by some sort of vehicle. Her broken pelvis was so severe that euthanasia was thought about. Dot's owner is a teenage boy and referral for orthopedic surgery was not an option. Even though there will be some arthritis in one hip, Dot showed an extreme will to live so she was sent home on cage rest, pain medication and antibiotics for her wounds.

A week or two later she started chewing on her injured front foot. Not just a little chewing. She actually chewed off one of her toes and did not want to stop there. She was not walking on the leg either. It didn't take long to realize she had nerve damage and had severe nerve pain in that leg. Amputation was the treatment needed to get rid of Dot's pain. Dot's owner kept her on pain medication and had her wear an Elizabethan Collar so that she could not chew anymore of her foot off while they were deciding what to do. But surgery is expensive and money does not grow on trees. It is a cold hard reality of veterinary medicine that the choice becomes one of letting an animal suffer or putting it to sleep even though, given enough money, the problem could be fixed. This is something that everyone who works in a veterinary clinic has to deal with on a daily basis. Whether veterinarian or veterinary technician or veterinary assistant, we all are in this line of work because we love animals. We empathize deeply with our clients. But if we did not charge for what we do, our veterinary practice would cease to exist. This is the reality.

I happened to be out of town at a family wedding when the plan to save Dot was concocted. The staff got together and decided that they would volunteer their time for Dot's surgery. Dr. Curie agreed to donate the drugs and supplies needed. I found out about the plan as I sat in a restaurant on the road with my family. Another vet assitant Christine called my cell phone to tell me about the plan. I was the last piece of the puzzle as I would be doing the surgery. My decision was easy. I could hear the excitement in her voice as she told me about Dot. Two days later, Dot had her leg amputation surgery in the evening after regular business hours were done. Katelyn, Christine and Carly assisted with surgery. Ashley drove to the clinic late at night to do a post-op check.

Did I ever tell you that the staff at Country Doctor is the best staff on the planet?

Oh how I wish we could do this all the time. As for me, I'd like to thank Dot for coming into my life. She is a reminder to give back to others from time to time. There is a song "Satisfied Mind" sung by Hal Ketchum and written by Tony Arata. I think this says it so well........

Don't think wealth is ever having all you want all to yourself
It is found when you are giving what you have to someone else
The only difference in the rich and the poor is a satisfied mind

Tuesday, January 19, 2010

Do you need any other reason than THIS to get your dog spayed?

Here is an interesting case from last week. Young female dog in her first heat cycle.

Nice, huh? This is called vaginal hyperplasia or more properly vaginal edema. This happens in some female dogs when they come into heat and the wall of the vagina swells and then sticks out through the vulva opening. As long as the owner keeps the dog from chewing on the exposed vagina and keeps the exposed tissue clean and moist, this will shrink back to normal when the female dog goes out of heat. Occasionally some females need surgery to remove this excess tissue. When a female dog has this happen once, it will likely happen the next heat cycle.

If you are not going to breed, get your female dogs spayed! It prevents so many problems.

Tuesday, January 12, 2010

The exploratory laparotomy

laparotomy: a surgical procedure which involves making an incision through the body wall to gain access to the abdominal cavity. An exploratory laparotomy is a diagnostic tool used to visually take a look at the abdominal organs.

I have spent 18 of my 24 years as a veterinarian practicing in rural America. My first job out of veterinary school was in the hills of southwestern Pennsylvania. At that time, the closest referral or surgical practice was a 3 hour drive one way. Most of my clients were farmers or had bluecollar jobs. Needless to say, I did lot more procedures and surgeries as part of my general practitioner duties than I do today. Part of it was youth and that willingness to try anything once that goes along with being young. But most of it was necessity. The time and funds were just not available to my clients to take their animals to a specialist. I did a lot of exploratory surgeries in those days. Sometimes I could fix the problem. Sometimes I couldn't. But many times taking a look inside allowed me to come up with a diagnosis and more important a prognosis.

My next job was in an upscale suburb of a big city. Veterinary specialties were just starting to open up in the area. As a general practitioner, having access to different specialities allowed me to take pet care to the next level. Specialists are able to afford ultrasound machines because of their higher case load. What a great tool for taking a look inside at the internal organs when x-rays do not tell the whole story. Ultrasound is a lot less expensive than exploratory surgery too in most cases. Sometimes surgery is still necessary, but sometimes surgery is not necessary or the prognosis is too poor to do surgery. During these years, I did very few exploratory surgeries. It just wasn't necessary to do as part of a family doctor type practice.

Now for the past 15 years, I am once again practicing in a small rural community. The difference compared to my first job is that there are referral practices only 60-90 minutes away. Ultrasound machines are still out of financial reach for a small town practice, but there are enough larger practices nearby so that as a family doctor, I can refer my patients to get an ultrasound when I have exhausted all of my diagnostic tools. But something changed last year. The economy. While I still give every client the option of going to a surgeon or internist, sometimes it just not financially possible. Once again, I find myself using exploratory abdominal surgery as a diagnostic tool. And it is a great diagnostic tool. There is nothing like being able to see what the problem is close up. And just like 24 years ago, sometimes I am able to fix the problem and sometimes I am not. Cancer is a common diagnosis in older dogs. But even cancers can sometimes be cured with surgery. Let me share with you a couple of tumors I removed during exploratory surgery over the past month.

First up is Jake. Jake is a 13 year old Border Collie that came in because he was sick. X-rays showed an abdominal mass. The mass was located on the small intestine and was able to be removed. It is a very slow growing cancer. There is only a very small chance the cancer will return. What is most important is that Jake is feeling back to his own self. Here is a picture of Jake's tumor taken out at surgery:

Next is Bailey. Bailey is an 11 year old SharPei mix that also came in because she was not feeling well. She had a big mass in her abdomen that I could feel during her physical exam. The mass turned out to be on her spleen so I removed her spleen. Here is Bailey's spleen and mass:

Bailey's mass turned out to be benign and she should have an excellent prognosis. Here's another picture of Bailey right when she was moved into recovery after surgery:

So here I am, 24 years after starting my career, doing things like I did at the beginning. What is that old saying? The more things change, the more they stay the same. Seems like veterinary medicine is the same way.

Tuesday, January 5, 2010

Snow week

I was going to call this blog "snow day", but then I realized that it has been snowing for the last 5 days with no real end in sight. About 6 miles east of here there is a National Weather Service observer that has measured 52" of snow so far in these past 5 days. Fortunately it is a very light and fluffy snow, so actual snow on the ground after a few days of settling is only 30". Now that makes it seem better. Not! The local businesses have switched from snow plows to front end loaders to move snow. We have been shoveling the sidewalk at the clinic nonstop, but within an hour, the snow is back. The good part about all this is that here in northeast Ohio, this is a fairly common occurrence during the winter. Everyone takes it in stride and life goes on almost normally if not just a little slower.
Good thing we don't use our basement door much. I just shuffled out through the frozen tundra to walk my dog though. Still wondering why I didn't wear boots today? Here's the view from the basement door up to the parking lot.

Yesterday I went outside to shovel my sidewalk at home and one my cats was gleefully running around in the snow. OK, maybe not gleefully, but he certainly wasn't hesitating about trotting around outside. Tough northeast Ohio cat! Caught this shot of him sitting watching me shovel the sidewalk.

All of this should be a reminder to take care of the dogs and cats in this weather. Don't forget to make sure your outside pets have a source of fresh water (not ice!). Make sure they have shelter from the wind and the wet. There is nothing I hate worse then to treat hypothermia or frostbite. Some short-coated breeds should just not be outdoor dogs in the winter. Period, end of story. Watch those large breed dogs (especially if they are overweight) as they go bounding through the snow. I can't even count the number of torn knee ligaments we see from over-exuberant bounding through the snow. Wash those paws if your four legged friend has to walk through ice melter. Some of it can be very irritating to the feet.
You may think I am crazy, but I love all this snow. OK I don't like the driving, the shoveling and barn chores are a pain in the neck. But it is beautiful. Just to watch the snow piling up outside brings back memories of how much fun snow actually was when I was a kid. The toboggan. The building of snowmen. The snow forts and snowball fights. Snow was not a chore. It was something to be played in and with. Snow got you out of school. Snow was special. It's nice to remember those feelings about snow. Makes me smile inside.