The Truth About Relationships

 

10834923_10204691662626259_I was a newbie when I became Scout’s vet 10 years ago. Her mom was a cool single lady who I always liked and Scout was a crazy young Golden.

At some point through the years, she started bringing her boyfriend in and eventually, we added him to the chart when they married. She was so happy for me when I was pregnant during the visit when Scout ate a sock, and shared that she too was trying. At the visit when Scout got into some Aleve I noticed she started to have acne and looked bloated as she shared the “trying” wasn’t working and they had started fertility drugs. After a few years, they began looking in to adoption. They would call for me to submit letters to adoption agencies that the dog was well behaved, Rabies vaccinated and they were responsible pet owners.

They followed me to various hospitals when I switched jobs or became a relief vet as Scout became an old arthritic Golden. When I opened my own hospital, her husband (a commercial landscaper) insisted on doing the new hospital’s landscaping at cost (free labor).

Over the years I stopped asking how the adoption process was going as they had many false hopes that never panned out. Until last year, when their dreams came true and they adopted the little cutie in this picture. The baby started coming to their visits too and I got to watch her grow over the year (she calls me “Auntie Monica”).

Tonight I was there for Scout and her family as they said goodbye and we let her go. I got to tell them it was the right thing to do (it was) and I saw the guilt leave their eyes. I got to be there for Scout, an old friend, who was so comfortable in my office she was snoring before she passed away.

This is not a sad story. This is what I love about my job. I watched this entire family come together and be a little part of their lives for a decade. I got to be an old friend to a dog who was ready to go and didn’t need to be scared or around a stranger in her time of need. And an old friend to her family who needed someone they trusted to give them permission to let her go. I love my job. RIP Scout.

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The Truth About Caring

 

You never forget your first patient. This is the story of mine and how he shaped the rest of my career as a vet.

The first three years of vet school you sit in lectures, watch others, and learn from the best and brightest vets in the world. But it isn’t until the fourth year that you actually see patients. Of course, you are still a newbie at that point, so you have a resident doctor who oversees you, guides you, and points out your mistakes (hopefully) before you actually make them.

My first “rotation” was an 8 hour shift in the ICU. It wasn’t a particularly busy night, so they only had one patient for me to oversee. Eight hours and one patient. Some of my classmates were jealous that I got such an “easy shift”. Others felt sorry for me because I wouldn’t get enough patients to learn as much as they did. I decided I would make the best of it and do right by my patient and not worry about what everyone else thought. I was given “rounds”, which is doctor talk for a Cliff Notes version of this animal’s story.

It always starts with name, age, sex, and breed: Bozley was a 10 year old, male neutered, Golden Retreiver.

Then what they’re in for: He was diagnosed with stage IV lymphoma (cancer) and was no longer responding to chemotherapy.

And then the plan: Owners plan on euthanizing in the morning; provide supportive care until the husband’s plane arrives tomorrow.

Well, there it was. My very first patient and my job was to keep him alive until his owners could arrive to let him go.

Bozley was a handsome boy. He had a shiny ginger coat and a completely gray face. His muscles were sunken in from months of chemo. His body was weak but his spirit was not.

WHAH - Dr Revel & BozleyI approached him to start my first official physcial exam. Thump. Thump. Thump. He was too weak to stand, but being a typical Golden, the sight of a stranger (me) approaching him gave him such glee his tail began to wag with vigor, knocking over his EKG monitor. I went through my whole physical checklist. I attempted to examine his ears with an otoscope. He turned his head and licked my face so hard I dropped the scope. I tried to listen to his heart sounds, but he climbed up on my lap as I was squatting and sat on me. I thought I could at least check his skin, but when my hand approached, he nuzzled my hand with his nose to indicate my instructions. I was to pet his head. I was to sit on the floor in the corner of the ICU with a Golden Retreiver on my lap and pet his head. After 20 years of schooling, countless hours of studying, tests, reading, learning….the best thing I could do for my first patient, my dying patient, was to care about him. So that’s what I did.

My shift started at 4pm and ended at midnight. There were hourly treatments; giving medications, checking vital signs, cleaning and nursing care. If they required me to stop petting Bozley’s head, he would nudge me in disapproval. As long as I pet him, he rested contently. He was so weak. He had fought a long hard battle and I knew he was ready to go. I read to him about lymphoma treatment protocols (I was supposed to be learning, after all), but I knew he had lived them. I looked at the pictures with which his owners had decorated his wall. Bozley as a goofy puppy. Bozley in his prime chasing balls through the vineyards of Northern California.  Bozley with his IV in getting chemo. Before I knew it, it was midnight, and the next doctor came in to relieve me.

I gave him rounds, he looked at the treatment sheet, saw the next treatment was due in two hours, and decided to go in the hall to study for the vet board exam until the next treatment was due. I knew if I left, no one would pet Bozley. These were the last 12 hours of his life. I figured the least I could do was give him the next 12 hours of mine. I stayed there with him all night. I couldn’t sleep because if I stopped petting him, I’d get the nudge. I couldn’t cure his cancer. I couldn’t help him regain his strength. All I could do was give him all he asked of me. So I ran my hand through the white hairs of his face, over the boney figure of his skull, and I gave him the best thing I had to offer: my care.

The next morning, Bozley’s owners arrived. I stayed with him and watched him breathe his last breath. I watched the life leave his eyes. And he was gone. And I wept with his owners. He went peacefully, surrounded by people who loved him.

I learned a lot from Bozley that has carried with me throughout my career. I am grateful for all that he taught me. It was nothing I could have learned in a classroom, from a lecture, or prepared for any test. Sometimes the best medicine we have to give is our time.

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The Truth About Ticks

This is a cautionary tale about trusting Dr. Google instead of calling your trusted vet.

Once upon a time there was a lovely lady who owned a lovely cat. As they sat on their lovely sofa watching what I can only guess was an episode of Lawrence Welk or the Golden Girls, the lovely lady was horrified to find a less than lovely parasite affixed to her precious cat. A tick. A big fat tick!

Well after screaming and running around the sofa a few times, the lovely lady calmed down enough to get in front of her computer and type her predicament into a search engine. Lo and behold, the solution appeared before her. She read what seemed like sound advice “Apply Vaseline to smother the tick and it will suffocate and die”. So she grabbed the longest cotton swab she could find and applied a glob of wonder jelly and waited. And waited. And waited.

Now that little tick was feeling extra moisturized and slippery in all that Vaseline, but he certainly wasn’t smothered. In fact he was wiggling his little legs even more now as if to taunt her.

Back to the computer to find a better solution. “Aha!” she thought, this site is much more reliable. “Apply a match tip to burn the tick dead”. Feeling rather clever, the lovely lady lit a match, blew it out, and applied the burning embers to the tick.

Well, it’s a funny thing about Vaseline. Seeing as how it’s made out of petruleum, it’s actually quite flammable. Just one touch of a just lit match tip and FLOOM! that lovely cat was now engulfed in flames!!!!

The lovely lady was a quick thinker. She grabbed her flaming cat, ran out her back door, and threw the cat into the pool to put out the fire.

When she finally brought the cat in to the vet, the cat was treated for severe dermal burns, near drowning (fluid in her lungs), and guess what else? Yup- tick removal. It turns out ticks are fire proof and can also swim. Thankfully the cat survived. But in her honor, I provide the following advice:

If you want to remove a tick, it’s very easy. You can buy a tick removal device (www.ticktwister.com) for a few bucks. Your vet probably has one and can remove the tick for you if you are having an urgent tick-mergency. You can even use tweezers. The reason they say to remove from the head is because if you pinch the body it will pop (and it’s filled with blood so that’s extra gross). There is no truth to the urban legend that if you don’t get the head it will burrow in further and grow another body. They are not zombies or geckos. They are just gross bugs.

If you are in the Los Angeles area, I will add that most ticks in our area do not carry diseases (Lymes Disease, Ehrlichia, Rocky Mountain Spotted Fever, etc.) so other than being gross, they are usually harmless. If you live in other areas, you should check with your local vet to find out if “tick titers” should be run on your pet after tick exposure.

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The Truth About Toast

Toast at Home

This is the story of what started out as a euthanasia.  A Good Samaritan brought in a cat she found dragging both rear legs down her street.  “Dr. Revel, you’ve got an ER in Room 2.  Looks like an HBC.”  That’s medical slang for “hit by car.”

I walked in the room and introduced myself the client.  I looked at my patient.  A tiny little four pound gray tabby cat.  One of the first things we vets do is to peel up the lip and look at the color of their gums…pale means blood loss, blue means can’t breathe, pink means good.  I was a little shocked to see perfectly clean teeth.  It was a baby, maybe a year old, but a very young cat.  Her gums were a little pale, but not alarmingly so.  She was so sweet.  She looked at me with these knowing and innocent yellow eyes.  Now just for perspective here, most HBC feral (wild) cats would be hissing at me and trying to claw my face off.  Not this one.  I put my stethoscope to her chest to listen to her heart and lungs.  What on earth?  She’s purring?!  I looked at her spine and back legs.  She had no sensation.  Zero.  They were both paralyzed.  Ugh.  There’s a reflex called “deep pain.”  It’s where we pinch in-between the toes really hard and they draw their leg away.  Well, they are supposed to.  She didn’t.  No deep pain.  That’s bad.  That means permanent paralysis. At least she couldn’t feel any pain.

Toast

I talked it over with the Good Sam.  She requested that we humanely euthanize this poor paralyzed kitty.  It was a reasonable request.  I took the cat to the treatment room to put an IV catheter in her that would deliver the drug that would allow her to peacefully pass away.  I pet her as the nurse placed a catheter.  Wait!  The muscles in her back legs were atrophied.  That’s a vet word for wasted away.  Atrophied!  That doesn’t happen over night.  She’s been this way for…well…probably a month.  She survived outside, stray, for a month with paralyzed back legs!  This was not a cat I could euthanize.  This was a cat who wanted to live!!!

I went back into the exam room to talk to the Good Sam.  I tearfully asked her if she would sign the cat over to me so I could find her a home.  She kindly agreed and very generously donated money towards the cat’s care.  I will forever be grateful to this woman.

I took some X-rays of the cats pelvis and abdomen (belly) and saw that her hip bones had been completely crushed.  Three of her backbones were luxated (out of place) but no broken spine.  On the X-ray I could see digested bone meal in her colon.  By some miracle, this cat had hunted on two legs.  Though severely emaciated, she was able to eat just enough to stay alive.  I treated her fleas and ear mites and put her in one of the hospital cages with some cat food.  Man, did she chow down!  I finished out the rest of my day at work, and did some online research into “cat carts”….wheel chairs for cats.  I said goodnight to my gimpy new friend and headed home.

The next morning it was back to work to start my 10 hour shift.  Hmmm….the cat didn’t look so good today.  A little lethargic.  Not purring today.  And I wasn’t hearing good breath sounds on the right side of her chest.  We put the ultrasound (sonogram) probe on her belly and saw a fluid filled uterus.  This is very bad.  99% of the time, fluid in the uterus means a uterine infection called a pyometra.  We’re taught in vet school, “never let the sun set on a pyo.”  That means, go to surgery immediately, do not pass go, or this cat will die.

We took full body X-rays.  Oh no!  There is was in all it’s glory.  Her diaphragm was torn.  The muscle that separates your belly from your chest was ripped.  Her guts and liver were in her chest right next to her heart and lungs!  Two of her lung lobes were collapsed and there was fluid surrounding the rest of her lungs making it harder for her to breathe.  The big meal I fed her the night before caused her intestines (which were in her chest) to get full which made her feel all the worse.  Her partial starvation was keeping her alive.   Lower in the X-ray you could see her fluid filled uterus, and still lower, her crushed pelvis.  My coworker took one look at this train wreck.  “This cat is toast,” he said.

There were two choices at this point.  Humanely euthanize or go to emergency surgery.  I never considered the first option.  Without much thought, I moved forward with option two.  Going in on an emergency pyometra spay, diaphragmatic hernia repair.  Once I opened her abdomen, her entire chest cavity would be exposed from the hernia.  You know on those medical dramas on TV when they call in the talented thoracic surgeon?  Well, that was going to have to be me.  A general practitioner, who hasn’t seen an open chest surgery since vet school, and, until this point, has certainly never performed one.  I’m not really sure what came over me, but I never stopped to hesitate.  I knew what I had to do and I was ready to do it.

We anesthetized the cat and prepped her for surgery.  I took a deep breath and began.  I slid my scalpel blade down the middle of her belly.  She was so thin, her skin was like paper.  Her tissues were paler than my usual healthy spays.  She was anemic from months of fleas sucking her blood.  I found her uterus.  Not what I was expecting.  Remember when I said fluid in the uterus was an infection 99% of the time?  Well, this was the 1% that wasn’t.  It was a cyst.  Weird.  But I didn’t have time for that.  I spayed her as quickly as I could, all the while knowing her open chest was just to my right.  I didn’t look there yet.   I stayed focused.

Spay complete.  Now for the hernia.  I extended my incision toward her diaphragm.  Oh boy.  There it was.  Her open thorax.  I saw the gaping hole in her muscle.  I gently guided out several feet of small intestine and replaced them to their abdominal home.  Next.  An entire liver lobe was stuck in the chest.  A four inch wide organ that I needed to deliver out of a three inch hole.  Kinda like delivering a really big baby.  Except this baby is the body’s detoxifying organ, so if I squeeze it, I could flood the bloodstream with toxins and kill the cat.  And if I knick it, she could bleed to death.  And if I widen the hernia to make it easier, I could knick her lung or heart.  No pressure.  Deep breath.  Gentle hands.  I delivered it through.

Now that I had removed her belly organs from her chest, I was left with a hole and a view to a live open chest.  I saw her tiny heart beating.  I saw her pale pink lungs inflate with each movement of the ventilator she was on.  Well, most of them.  Two of the lung lobes on the right were collapsed, useless flaps of flesh that every specialist would agree would stay permanently so.  I grabbed some non-dissolving suture.  I stitched the hole closed.  That closure needed to last her a lifetime.  I took more suture and sewed it again.  I once saw a TV show where they said anyone worth shooting once is worth shooting twice.  Well, I figured this hole was worth fixing twice.

With the last stitch, I placed a tube in the chest cavity and sucked out all the air around the lung space.  I closed her up.  All the kings horses and all the kings men….well, they should have gone to vet school.

I took the cat home with me to foster her.  Her wounds healed.  Her hair grew in.  She gained nearly 3 pounds!  I knew all of that would happen.  But what I never expected and would have guaranteed would never occur, is what happened next.

I took the cat to several veterinary specialists:  a surgeon, a neurologist, a physical therapist, an acupuncturist.  All were in agreement.  There was no surgery to fix her shattered pelvis and the nerves in her back right leg were dead.  She had a small amount of nerve function in her left rear leg.  So the plan was, try to strengthen her left rear so we can amputate the right rear.  Cats can do really well on three legs.  Otherwise, she would need a wheel cart.  I started physical therapy daily (which she purred through, every time) and acupuncture once a week.

Within a week, she was moving both back legs!  She was still dragging them and knuckled over, but they were moving!!  Both of them.  By week three, she was no longer knuckle walking, but actually walking on her paw pads.  Like a normal cat.  With no nerve sensation.  She could step over an obstacle, go up and down the stairs, and even jump onto the counters and window sills.

How on earth this cat is able to walk will remain a mystery to every veterinary professional involved in her care.  As I write this she is doing her favorite thing….sitting on my lap purring.  I’m not sure how many of her nine lives she sacrificed surviving a shattered pelvis, 3 luxated back bones, 2 collapsed lungs, flea bite anemia, partial starvation, a diaphragmatic hernia, pleural effusion (fluid in her chest), and most significantly, a vet who had already drawn up the euthanasia solution to put her to sleep.

Like most vets, I am a sucker, and this amazing cat who taught me so much about not giving up ended up finding a pretty good home….mine.

Sometimes, when I am watching her, I think back to that horrific X-ray I put up and the general consensus of every reasonable person that said ”this cat is toast.”  I’m glad I wasn’t reasonable on that day.  But I did name her….Toast.

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