Leroy, my Border Collie’s birthday is not until January, but every year I throw him a huge birthday bash and I start the planning for this event months ahead of time. I was just speaking with some family members about the theme for his upcoming 8th birthday and they reminded me of a funny story from last year’s party.
The dog party is most frequently catered by Organic Doggie Kitchen who makes healthy dog friendly treats in fun shapes to add to the theme of the party. Last year Leroy turned 7, lucky 7…my they grow so fast! So our theme was a casino theme and the cake was none other than a giant Ace of Spades cake. The rest of the table is covered with trays of dog cookies in the shapes of poker chips, slot machines and other casino themed fantasies. Twenty five dogs attended last year and there was utter amazement in the air that every single dog was behaving!
Then lo and behold just as I was walking around to get people’s attention from every corner of the room to let them know that we would be cutting the cake soon, one of the dogs had an idea of his very own. I turned around and literally watched this fabulously athletic Beagle run across the room and bound directly onto the table and straddle the cake!! I guess he thought that either it was his birthday or we humans were taking far too long to cut this delicious looking cake.
Despite all of his efforts to get onto the table, all he did was steal a few licks of frosting and enjoy each and every smattering! The owner felt so badly but everyone thought that it was the most hysterical thing that they had seen …almost to be expected with a room full of dogs. We were all actually pretty surprised that it hadn’t happened sooner.
The cake was large enough that every other dog had a large smattering of dog birthday cake as well and a fun time was had by all. This was just one additional event that put a smile on the face of each and every dog owner in the room, probably thinking back to the last time their own dog stole a crumb off their counter…
As I had stated in an earlier blog, we were waiting for a sign. Little Mookie was hanging on; we just weren’t sure what we were going to do. One morning, I heard a thump, and found that she had fallen down the stairs to the landing. I rushed to her, picked her up, held her, petted her, and she stood and walked away, and I thought she was okay. However, by that night, the little girl was unable to stand.
We had not wanted to rush to euthanasia; it’s such a serious and momentous decision. We had asked for a sign and this was it. She did not seem to be suffering. She was not in pain. But we could not let her continue. This little girl could not stand, she could not walk.
With the help and support of my staff, we did what we had to do. They came to our home the next day so she did not have the added stress of traveling to the office. We put an IV catheter into her leg, gave her an injection of Valium to help her relax, and gave another injection so her heart would stop and her breathing would stop. She went very peacefully and we were holding and petting her the whole time.
Her suffering was over. We felt great relief and great sadness. Then my staff, being the extraordinary people that they are, sent a card that they all had signed. They sent us flowers that were lovely and graced our table for over 10 days. They made a contribution to Virginia Tech in Mookie’s name. They reached out and touched me and held me and touched and held my wife when we needed it. We have very mixed emotions as to what’s going on. Great sadness and great loss, and when we think of her, our eyes well up and there is an ache in our hearts. But at the same time, we feel great relief. Her suffering is over and we did not have to force a decision. She gave us the sign we needed.
The irony is the great cycle of life. We put her to sleep one day, and three days later, had a shower for our soon-to-be grandson. So here we dealt with the loss of one, and the joy of the other. That’s the great cycle of life. We are so thankful for the support of our family and friends, the ones that loved her, and helped us reach such a decision. I know that Mookie’s up there now running all around, free of pain and wreaking havoc on our other little one, Mo who went before her but never ceased to torment her in life!
Judy and I are still struggling. Little Mookie has good days and bad days. The times we think we’re ready to make the decision to stop, she responds. When Judy calls her to eat she seems to be aware of what is going on around her. Some of the time, she just doesn’t seem to be aware of her environment. Her brain does not always seem to be connecting. It is a terrible decision, we’re responsible for this little cat’s life, it’s inconvenient, it is difficult to have her think that the entire upstairs is her cat box. It’s a terrible situation.
We’re waiting for a sign; we’re waiting for her to show us that she’s done. That is what we need; we need her to let us know that life is not good for her. I don’t want to prolong anything. Judy does not want to prolong anything that is not in Mookie’s best interest, nor do we want to stop prematurely. I identify with all my clients that get to this phase. It is a terrible situation and a terrible decision.
I know that the time is coming soon. I know we will eventually have two more cats and we’ll have the happiness and joy of cats running around the house again. Right now our role as care givers is to support her and make her as happy and comfortable as she can be at this time. When she’s ready, when she gives us that sign we will stop. This is a message I share with our clients. This is the message that Judy and I share with each other. It is a difficult time, but we’ll do what is right for her.
One has to be careful in making assumptions. We have to confirm the diagnosis. The reason why we do X-rays is an example. I remember when a dog came in that had been referred to me for knee repair. A big Malamute came in limping and appeared to have an anterior drawer sign, the sliding motion in the knee joint when the tibia and the femur slide back and forth because of torn ligaments. Under X-ray we found, that instead of the sliding motion being caused by a torn ligament, the dog actually had an osteosarcoma (malignant bone tumor) that had eaten up the leg. It was a fracture caused by the cancer that had created the sliding motion.
It’s important as veterinarians that we continue to remember not to make assumptions with our diagnoses, but to look and pursue and make sure that we confirm our diagnosis so we can treat appropriately. Instead of repairing the knee we performed an amputation to give the dog as much quality, pain-free time as possible and then referred him to an oncologist for chemotherapy.
This next story is about a little Westie who came to see me. This dog has had heart disease for some time. The dog’s on medications to control the heart disease. He’s owned by a delightful client…an elderly lady who lives by herself. Her husband had just passed away, and this dog means everything to her. So imagine my dismay when I received a phone call that the dog was coughing. When treating cardiac disease, a cough is usually an indication that congestive heart failure may be forming. Congestive heart failure can be life threatening if not treated, but can many times be dealt with when caught quickly, and we wanted to make sure what was going on.
Did we need to adjust the cardiac medications; did we need to add medications; what was happening? This dog was already on a plethora of cardiac medications, and I was concerned that there was not much left that we could do. I was really distressed because the last thing I wanted to do was lose this dog, just as I don’t want to lose any dog. So then the client came in with the pup, and sure enough, as we were listening to some harsh lung sounds, we took X-rays, and found that the heart was enormous, about the size of Cleveland.
I, in my heart of hearts, feared that the dog had congestive heart failure, but I had decided to see where we were going, and I had my radiologist do an echocardiogram on the dog. The good news is the echo showed that although enlarged, the heart was stable. The cardiac drugs that we were using to treat seemed to be doing the job. Instead, it appeared that this animal had treatable pneumonia and we needed to just increase the antibiotic level. The dog has been on antibiotics and has responded very nicely. There is an expression in veterinary medicine, “When you hear hoof beats behind the barn, don’t look for zebras”. In this case, it was not quite a zebra and the good news is, because of the X-rays and the echo we were able to make the right diagnosis and the dog is doing very well.
As I said before, “If It walks Like a Duck, Quacks Like a Duck, Looks Like a Duck, It must Be a Duck”…NO, Not Always!!
Very frequently owners find themselves rushing their dog to the groomer or vet and forgetting to cancel their daily dog walk. This day was no different than any other in that aspect. Jane was a busy owner of two happy Beagles. She was a great pet owner who always took fabulous care of her pets and they wanted for nothing. But as anyone who has ever spent any time with a Beagle knows they have a certain love of food that cannot be easily tamed.
I arrived at her apartment ready to walk both dogs…and they usually both walked in opposite directions so I can’t say that I was disappointed when only one dog was home. I called Jane just to let her know that Angel did great on the walk and that I assumed that Beau, the other beagle, was with her or at an appointment. Jane called back to say, “No, Beau should be there, as far as I know he is not otherwise engaged.” Thankfully Jane’s voicemail came promptly after my call so I was still in the area and returned to her home to try to figure out how Beau had vanished into thin air.
I walk all around the apartment and check all the closets and bathrooms. Lo and behold, as I stood there in silence, completely befuddled, I hear some rustling coming from under the sink of all places!! I open the cabinet and sitting in front of me is the happiest Beagle that you can imagine as he just finished eating half of his bin of dog food.
In this case all turned out well but I always tell owners this story since it serves a twofold purpose. First and foremost owners should always do the best that they can in dog-proofing their homes so that dogs don’t get into anything that could be dangerous to them. This time is was only food but sometimes hazardous things such as antifreeze can taste sweet to dogs and in that case this would not have had a happy ending. Second, Beagles are breeds that are ruled by their noses. So when choosing a dog make sure that you know just what you are getting yourself into!!
The rewards we have in veterinary medicine are many. They come in many forms and shapes and sizes. Obviously there’s great satisfaction in a job well done when the skin lesions clear up, when the medical problem takes care of itself, or heart conditions are under control, that the surgery goes well. But let me share a story with you…
The puppy came in three legged lame. He had bone on bone rubbing — that’s called crepitus and that indicated it was a fracture and the fracture was in the femur or the thighbone. It occurred when the dog jumped from the car. The family was extraordinarily distraught. They had been given a quote by a team of specialists and it was way out of their range to get the leg fixed. I looked at the leg radio-graphically and felt that we could deal with the situation and help them financially.
We went in surgically and put in two intermedullary pins to stabilize the fracture. I used two pins versus one pin because it stops rotation at the fracture site. It’s a young puppy and I felt that the bone would heal and the dog would grow and run and play. The good news is that the dog is healing. It had to go through a couple of adjustments with the pin because the puppy was just too active. Geez, I guess the pain wasn’t there and we were doing the job.
The young family was very appreciative and we were able to work out terms with them to help them so they could pay the bill later and make the bill less painful. The young girl in the family was very inquisitive and asked a lot of great questions. She sort of reminded me of Colombo, just one more thing Doc. So the dog is progressing nicely and I was very pleased when in the mail came a picture of the pup and a wonderful note from this young lady who said thank you for saving my dog’s life.
It’s always wonderful and affirming to receive a handwritten note about a pup who is running and playing, saying thank you, you saved my life. That’s what we do this for — rewards in veterinary medicine are many. It’s the smile of the kid, the relief in the parent, the puppy who is running and playing and able to walk again, especially exciting. I love what I do.
I love to do knee surgery. Knee surgeries are fun to do because the results are usually extraordinarily rewarding. They almost always come in limping and they have a diagnostic sign called a natural drawer, when there is a sliding back and forth of the tibia and fibula, or the shin bone and the thigh bone. This can only occur if the cruciate ligaments, the cross-ligaments in the knee, are ruptured. I use a modification of an imbrication system that allows for stability of the animal’s leg and these dogs are up and about and walking very, very quickly. I’ve done them on 180 pound dogs and I’ve done them on 20 pound dogs, and the results and the rewards are great. The dogs respond nicely to therapy. I use the cold laser after the procedure and they do well.
So when the dog came in, shepherd mix, with the classic onset of lameness, out running in the yard, cried out and came in limping, I just wanted to check to see if the knee ligaments were ruptured. Indeed, we were able to demonstrate that anterior drawer sign when we did our exam. Xrays revealed no evidence of any problems in the hips or knees other than the torn cruciate and we elected to proceed with surgery. The chest films and pre-op blood work were fine.
Now, let’s talk about how important it is to monitor vital signs during procedures. The dog went under anesthesia. We used sevo fluorine, which I believe is the safest gas anesthetic available in the veterinary market. We were having a hard time maintaining reasonable O2 levels and the dog was having difficulty. O2 is the animal’s oxygen concentration in the blood and if the oxygen concentration isn’t sufficient, then obviously the oxygen transfer through the red cells is not sufficient. We aborted the surgery and had our ultrasound radiologist doctor come in to do an echo of the chest.
The dog had severe COPD, Chronic Obstructive Pulmonary Disease. The chronic pulmonary disease warranted treatment first. We held the surgery and we’ve been treating the dog’s knee with pain medication and cold laser to provide relief. The dog is walking better. Follow-up x-rays revealed that there is still COPD present, but the dog is improving.
Will we be able to get that knee repaired? I’m not sure, but I thank my lucky stars that we had good technical supervision and that we were able to demonstrate that this dog should not be under anesthesia, that we aborted the surgery and took care of what the dog needed. It was another day that was successful, in my opinion, even though the outcome was not what I had planned. Just another good reason for diagnostics and monitoring. See you next time.
Stinging insects can be a terrible problem. Dogs can end up with a serious anaphylactic (a reaction where the eyes swell, the throat closes and the dog can’t breathe) reaction. I had three dogs come in on the same day that had been stung by bees. Bee stings made their faces blow up. They were swollen throughout their legs and feet. Their eyelids were swollen. These dogs were in serious shape. Two of the three dogs had lung changes on X-rays. We put them on IV, steroid therapy, Benadryl therapy and drugs to try and help bring the inflammation down. The good news is they did respond. The good news is that they were able to go home after some intensive therapy, and indeed, are doing very, very well. All three dogs ended up taking some Prednisone (a steroid that helps reduce inflammation) home with them so that if the reaction were to occur again, the owners could immediately start some prednisone at home, contact us, and get in right away.
Stinging insect reactions can be, in some cases, life-threatening. It is very important that if your animal has a sensitivity to stinging insects, you immediately get them under control.
I have commented before about my great staff. To show you how sympathetic my staff is, my senior technician went home on the weekend following the stinging insect reactions, and was out gardening. Just to show how much she related to the animals she had been treating, she got stung by a stinging insect. She ended up in the hospital with a serious reaction, and is on heavy medication. She also has sensitivities, it seems, to this kind of reaction. Something that we need to watch very carefully.
Take-home message: watch your pets, particularly when the yellow jackets, bees and wasps are out. If you see any kind of reaction that looks like it may be of any concern, get to the doctor right away.
Today is another day. Thank goodness. Yesterday was a tough day at work. I’ve got a great staff. We normally function like a well-oiled machine. They know what I need. I know what they need, and we get things done timely, efficiently, and for the well-being of the client and the patient.
Yesterday we still did that efficient and good work for the patient, but we were not working well together. There seemed to be some underlying tension, some not-quite bickering, but people were just off. I was ready to go sell puka shells at the beach. It was just not a fun day. The work went well, we got things done, but we were not working as that smooth, cohesive unit as we usually do. It was extraordinarily frustrating. This is not the way I like to work. I like and respect my staff, and they like and respect me, but something wasn’t clicking right.
I went home and told my wife, okay let’s go sell sea shells by the seashore, I’m done. But I came in today and I said, today is another day. It was a great day. We were extraordinarily busy. We worked well as a unit. We laughed, we got work done. We were efficient. Patients and clients were well served.
You see what it comes down to is working as closely hand in hand with the staff as you do in veterinary medicine with people that you’ve worked for 12, 14 years is like working hand in hand with family. There are some days that are better than others. The good news is this was a good day, and the good news is most days are good days.
The take home message: you don’t need to pick battles, you don’t need to have wars. You don’t need to let little details bother you. The take home message is you choose a group of people that you like, respect and want to work with, and know that like any family there will be days that aren’t always as smooth as you want but there is another day coming.
I am blessed to have the people I have working for me. I am blessed to have such a supportive staff. I am blessed to have the staff I have because they help and support and carry me in so many ways. I do not want to sell puka shells on the beach. Instead I want to work with these people for many more years.
The three cats with ultrasounds all had pretty good news. The one cat I was concerned about because we had seen some transitional cells in the urine. Transitional cell carcinoma can be a serious tumor. The ultrasound showed some chronic kidney disease, inflammatory bowel disease, but not cancer. We will continue to treat this cat and it should do well.
The second cat had a spike of a liver enzyme, ALT. This is a cat that I’ve been treating for chronic inflammatory bowel disease. The good news is that there’s no evidence of any tumor. The cat did have an elevated thyroid enzyme. We will treat this cat for hyperthyroidism and hopefully all will go well with that.
The last cat is a cat that I had been treating for some time with a tumor in the intestinal tract. We had been treating this medically and supporting the cat with injectable steroids and antibiotics and his enzymes had spiked. The good news is, again, we did not find any tumors in the liver, just some chronic inflammation and hopefully he’ll continue to respond.
At the same time, we had to do an ultrasound on a Sheltie that came in with a very high lipase because of pancreatic enzymes. This dog had come in — he got sick in front of my eyes, as I watched him get weak and stagger. And, it appeared that the good news is it just had a hematoma (a collection of blood) in the neck and with IV treatment for the pancreatitis and IV antibiotics, responded dramatically.
So, the good news is with all these serious cases, they all should respond medically for some time. While some of these are chronic diseases, which will eventually win, the patients are happy and comfortable and should do well for some time. I consider that a good day.
P.S. The hyperthyroid cat is doing great. The elevated liver enzymes dropped 50%. The chronic kidney cat is responding and the third cat is holding its own. The Sheltie has normal pancreas values and the red count is back to normal. The team did really well with these cases.
Leroy, my Border Collie’s birthday is not until January, but every year I throw him a huge birthday bash and I start the planning for this event months ahead of time. I was just speaking with some family members about the theme for his upcoming 8th birthday and they reminded me of a funny story from last year’s party.
