This was an insane case that took everyone in the clinic on a roller coaster ride!
"Sunny" was a 5 year old female spayed Beagle. The owners called, concerned, a few hours before close because the dog was straining to urinate and didn’t seem to be producing anything for the past day. They lived over 100 miles away but promised they could be there before we closed. We asked if they wouldn’t rather take her to a clinic in their rural town but they said they trusted us and would rather she come see us.
They made the three hour drive and arrived 45 minutes before close. I was hoping that she would just have a UTI, since complete urinary blockages are very rare in females. But she sat there on the exam table wagging her tail and then trying and trying to urinate, and not producing a single drop.
I took the first x-ray and groaned. Her bladder is HUGE. There are also a cluster of stones in the bladder, which at first distracted me from the real problem — the stone in her urethra, visible behind the pelvic bone. It was huge as well.
With a sinking heart I told the owners that she had a complete obstruction. The owners looked to each other in tears. They had significant financial constraints. I told them that a surgery tonight to remove the blockage would likely be $2000-$3000 at an emergency hospital. They could also try to have her catheterized so that the stone could possibly be pushed back into the bladder (where it would be unlikely to fall into the urethra again), but with anesthesia and hospitalization that would still cost $1000 and might not work anyway, it’s very difficult to catheterize female dogs.
The owners wanted me to try calling a few e-clinics to see if anyone thought they would be up to catheterization. I tried the two local clinics but no one there felt confident in their female dog catheter skills. I called one further away and they thought they could do it, but the $1000 price tag was still the owner’s whole paycheck.
The owners were crying as they told me they would have to put her to sleep, since they couldn’t afford either procedure and knew they did not want her to die at home from an obstructed bladder, which is a terrible death; toxins fill the bloodstream and the bladder begins to die or can even burst. I told them we would have the tech go over the estimate, and gave the dog a huge handful of treats, which she ate with joy, wagging her tail.
Agonizing I went into the back, wiping the tears from my eyes. It was horrible! She was only 5! What bad luck it was to get blocked as a female dog (whose short wide urethras usually protect them). I felt sick but at the same time knew that I did not want her to just die at home. I knew I couldn’t catheterize her (I couldn’t even do it in a cadaver at school, let alone in a life or death situation) and was just feeling awful about my inability to help. Death seemed so wrong and yet was better here than slowly dying at home.
While the technician was going over the estimate for euthanasia I suddenly heard a call for me. “Doctor!!!” I hurried down the hall and there was a most beautiful sight — the Beagle wagging her tail, standing proudly next to a huge puddle of urine and the HUGE stone in the picture. SHE DID IT! SHE PASSED THE STONE!
We snapped one more x-ray and voila! The small stones are still there, but the bladder was tiny! One owner ran at me with her arms wide in a huge hug when I showed her the x-ray. Every tech and receptionist was sooooo relieved, we all left with the hugest smile on our faces when we sent them home with food to dissolve struvite stones and antibiotics. YAY.
If there had been any less delay in any of those scenarios — they hadn’t made the drive, they hadn’t had me call around — we could have had them sign those papers sooner and she wouldn’t be here. It really felt like a veterinary miracle!!!
You guys don’t do cystotomys on bladder stone dogs??
We definitely do, but this was 7:45 PM and we close at 8 PM, as a day practice with many nearby emergency facilities we would rarely if ever make staff stay long enough for a surgery and recovery to occur. The dog wouldn’t be able to wait until the morning with how big her bladder was, either. Also cystotomy at our clinic is about $1500, the owners couldn’t even afford $1000. Finally, with the stone in the urethra, there would be a possibility of not being able to get it to move, with surgery being needed on the urethra instead of the bladder - a surgery I have no business performing since I’ve never even seen one occur. So there were a lot of reasons cystotomy was not an option at that point and in our clinic.Edit - in response to one person’s question about doing a cystocentesis to remove urine annoy the dog time — it might have worked, but there is a risk when you poke an obstructed bladder that the tissue might already be damaged and could be necrotic. If you poke in a necrotic area then you could possibly rupture the bladder and cause a uroabdomen. Since I didn’t know how long she’d been blocked I didn’t take the risk.
Written by http://oncekitten.wordpress.com
The dating website eHarmony has published a wonderfully upbeat, but sadly unrealistic list of reasons why dating a veterinarian is a good idea.
So in the interests of singletons everywhere, I’ve written a few corrections to save everyone the time and heartbreak when it all goes wrong (and because if you read no. 15, you will see we have no interest in consoling our colleagues)
1. They’re patient. Their furry patients can be stubborn and aggressive.Vets respond to chaos with patience, gentleness and a calming demeanor.
Just don’t expect your date to extend you the same patience when she’s just finished a 14hour shift being lacerated by angry cats and trying to convince her clients that 5+ years of training means she probably knows better than the 16 year old sales clerk in Pets at Home.
2. Veterinarians are passionate about their work. They don’t choose the career for its prestige or the money, they do it because they love it.
Translation: You’re paying for dinner (unless you fancy Royal Canin samples of course)
3. Veterinarians work hard. They endure countless years of tough schooling, long hours at clinics and unexpected middle-of-the-night calls.
Your date will be likely to cancel at the last minute, perfect if you’re looking for a partner that you don’t have to see that often (which is quite likely given no. 4+5).
4. Scrubs are cute.
Not when they’re covered in blood and pus and faeces.
5. Veterinarians have seen it all. Nothing grosses them out. Or, if it does, they persevere through it.
Your date will have absolutely no concept of ‘appropriate dinner conversation’.
6. Date a veterinarian and you’ll be dating someone who saves lives, eases pain, and helps lives end with dignity.
Dignity is overrated. Your date will also be someone who spends a large portion of her day with her hands in unimaginable places, crawling around on her hands and knees and picking fleas from her scrub top.
7. Veterinarians have thick skins — literally. They endure scratches and bites in the quest to make the lives of our furry friends better.
Great if you’re into that ‘emo’ look, not so great if you don’t want to be eyed with suspicion every time your date gets her forearms out in public.
8. Veterinarians have rigorous hygiene standards. (No, your date won’t smell like a barn when she arrives for dinner.)
If your date treated a sheep any time in the last week, she will smell of sheep (Has this person ever actually met a vet?! )
9. Veterinarians are smart, quick problem solvers, making life-and-death decisions on the spot and quickly assessing serious problems.
Your date is exhausted and wants nothing more than a large glass of wine and to spend the evening watching Made In Chelsea and browsing Buzzfeed.
10. Veterinarians are big-hearted, often shedding tears with pet owners when animals’ lives end, and rejoicing with them when little miracles happen.
Translation: Vets have the highest suicide rate of any profession (also great if your into the emo thing)
11. Veterinarians have the strength to do the right thing even when it’s difficult.
Lucky veterinarians have wonderful vet nurses who they get to do the right thing when it’s difficult.
12. A sense of humor. Vets are able to laugh at the messes and stresses that comes with working with animals all day.
Translation: Your date will be one of the most cynical, sarcastic people you will ever meet and will tell jokes that will make you vomit in your own mouth (unless anal glands and exploding abscesses get you going)
13. Veterinarians make kids smile, helping their pets recover from injuries and illnesses, and showing them how best to care for their canine pals.
Veterinarians also kill children’s pets and make them cry. If your date liked children, she’d have become a paediatrician.
14. Veterinarians have impressive job descriptions. They’re anesthesiologists, radiography technicians, surgeons, teachers, babysitters, physical therapists, playmates, protectors, cleaners, pharmacists, and best friends to needy animals.
Your date will have no time for housework, cooking or a social life and will spend most evenings researching difficult cases.
15. Veterinarians know how to reassure others in stressful, difficult times. They know how to prepare people for bad news, and can console them when that bad news comes.
Veterinarians spend all day dealing with stressful situations and delivering bad news. If you want sympathy and understanding, date a therapist.
Cats are very stoic and it’s easy for cat parents to miss signs of pain or discomfort. Because your cat can’t come to you the way a child can and verbally complain about being in pain, it’s important for you to pay attention to physical signs as well as changes in behavior or routine that could possibly be a red flag. If you suspect your cat is in pain, please don’t hesitate to get him to the veterinarian.
Here are 10 signs that your cat may be in pain:
- Increased vocalization
- Licking a particular area of the body more than usual
- Appearance of the nictitating membrane (the third eyelid)
- Panting or open mouth breathing
- Irritability or grumpiness (from a cat who normally isn’t that way)
- Lack of appetite
- Change in mobility (signs of limping or reluctance to move)
- Change in litter box habits
- Increased clingy/needy-type behavior
Many signs of potential pain can be very subtle and easily missed. For example, if you aren’t routinely scooping the litter box twice a day you’ll miss the fact that your cat hasn’t urinated or defecated in there for a day or two.
If your normally friendly cat starts becoming short-tempered, don’t write it off as kitty just being in a bad mood. Cats are creatures of routine and a change in behavior can be a warning sign of something medically wrong. Don’t play wait-and-see when it comes to your cat’s health. Your cat may be communicating in the best way he knows how that he’s hurting and needs help.
cats that have faces like this with the colors split down the middle means that there were two cats in the mummy cats womb that merged together in the early stages of fertilization.
it’s actually called a chimera and is when 2 eggs fuse and 2 sperm fuse and then fertilise eachother to create an organism with 2 seperate sets of traits but we can make stuff up i guess
My sweet baby. She followed me around and whined until I snuggled on her couch with her. Yes. My old lady has her own leather couch that we put her blanket on cause the leather gets cold.
It’s hard to watch her move slower but she is still stubborn and sassy as ever.
Me: X-ray’s up! *hangs film up on viewer* Well, there’s the problem, doc!
A few days ago, this small hound dog was hit by a car, and he presented exactly like the diagram from the vet’s textbook. We x-rayed him, and sure enough, his hip was dislocated. So we sedated and tried to set the hip. Except it’s a lot harder than the movies make it appear! We just could not get it. So we called in the large animal vet, and even with us pulling to hold the body still, he had to pull on the leg for all he was worth to get it back in place! After a repeat radiograph confirmed the head of the femur was back in the acetabulum, we placed a modified Ehmer sling. We tried a normal one at first, but it kept slipping off his stifle thanks to his stubby little beagle legs…
For pain we started him on tramadol, as NSAIDs (such as rimadyl, previcox, or metacam) are contraindicated because you actually want that inflammation to help hold the joint in place while it heals.
He’s doing well so far, but will be out on strict cage rest for the rest of the season. If the owner tries to run him again too soon, the joint could easily luxate again and cause enough damage to ruin his career permanently.
Asked by theshoelace
Aww shucks! Thanks for the compliment :)
That’s terrible that you saw an animal pass away during surgery! I can remember maybe two or three incidents during my clinical rotations, but so far in my first year of work, I have been lucky to not have one die during surgery.
It’s quite a daunting experience, but we need to remember that all procedures carry a certain risk, not only a surgical risk, but also the anaesthetic risk. I think that it’s inevitable to experience this tragic incident, so I think it’s important to know that it’s okay to feel grief for the animal. I personally allocate a period of time (usually my drive home) to mourn for any death in the clinic, and to shed a tear for the clients who have lost a family member. This is so I make sure I don’t detach myself completely from my patients, as when I’m in clinic talking to clients I have to maintain a coolheaded professionalism even when I know the outcome is bad. It also lets me reflect on anything I could have done better for the process to be smoother.
Finally, I remember a time back in clinical rotations when I thought I was responsible for a pet’s death. I was hysterical and beside myself, thinking that I could never be a qualified vet if I already killed a life! (I didn’t, I just thought I did…-_-“) The university clinician at the time sat down next to me, and without a word, gave me half his chocolate bar. I asked him how he managed to stay so calm in a situation like this, and he said, “Trust me, I’ll be in your shoes as soon as I get home. Right now, the client is counting on us. Even if you feel like the world is collapsing around you, there is a client in your room looking at you for guidance.”
And that is what keeps me going, because I know that at the end of the day, I tried my best for the animal.
NEW GRADUATE PROBLEMS
What good is misery if you can’t milk a little humour out of it, right. Will probably make more of these, because if I’m not laughing I’d be sobbing instead!
These are absolutely amazing, perfectly sums up how I’m going to feel in January on my first clinical rotations!
Misconception #36: Everything Said by “Dr”. Andrews and 20/20
I am going to reference Pawcurious’s blog because she laid this out pretty nicely. Nov. 22, 20/20 aired an episode focusing on “unethical” vets, and their star witness was a self confessed poster child of unethical vets (credible…
As most of you know, I recently switched jobs from a day practice and now work in a 24 hour hospital as an Emergency Veterinarian. I absolutely LOVE this aspect/side of vet med, and I wouldn’t (and don’t) want to do anything else… ever (like every other vet, I am a type-A overachieving work-a-colic). However, there are moments when I am hit with the reality of what my job REALLY is, and I wanted to take a moment and share with everyone my experience, especially in light of the recent media regarding vet med.
I walked into work this evening at 5:45pm ready for my overnight shift, and felt like I was walking into a room of chaos. I took a moment just to evaluate my surroundings and see where I could jump in and help. What I realized was: 1) there was nothing for me to do, and 2) the hospital at that moment was the reality of vet med.
*I would like everyone now to really try and picture what I am about to describe. For my vet friends, this won’t seem out of the ordinary… in fact, this is probably every day. For those that are not vets, it will give you insight into what YOUR vet REALLY does… it is not all happy healthy puppies and kittens… actually… it is UNCOMMONLY puppies and kittens…*
Sitting in the back on one of the treatment tables was a cardboard coffin with a 5 month old puppy in it, waiting to be picked up by it’s owner. This puppy had passed away during a neuter. Come to find out during surgery, that the puppy had several congenital abnormalities that were hidden from pre-op bloodwork and physical exam (every precaution to make sure anesthesia and surgery is as safe as possible), and only discovered during surgery, causing the puppy not to wake up after anesthesia. Any veterinarian will tell you that a neuter is one of the simplest surgeries that we do. We could do it in our sleep. However, unseen complications happen, and there is nothing that anyone could have done to prevent this from happening. This was an unhealthy puppy that was not going to live a long and happy life, it would have gotten very sick and died at a very young age. However, the veterinarian that performed the surgery was devastated. This was the first time this had ever happened to this veterinarian in 5 years of practice… 5 years and countless surgeries. Put yourself in this vet’s shoes for a moment: You just lost someone’s baby under anesthesia for a surgery that YOU recommended. Colleagues and even your own head tell you - This was not my fault. There was nothing that I, or anyone could have done. This happens to everyone. But your heart only feels pain and guilt and anguish for a life lost and your failure, and an inability to serve the purpose that you were put on this Earth to do: HEAL. Now comes the hard part (I know, like everything else isn’t hard enough!). You now have to get on the phone and call the owner of that puppy and tell them what happened. You get to break the news to mom, dad, and their son (the person the puppy was bought for) that their best friend is gone. You get to tell someone who is excited about playing fetch and running around in the yard, you get to tell them, I am so sorry, but your dog is dead. It puts a knot in your stomach and chest that nothing else can. It makes you sick and hurt to the deepest part of your soul. You hurt for the owners, for the puppy. You hurt because you caused PAIN.
In this same moment there is a dog and owner in a room with another doctor. This dog has been unwilling to eat and unable to keep anything down for the past WEEK… and oh yea, the dog ate a cactus a little over a week ago. The poor dog is so sick and painful it won’t let the doctor feel it’s belly. Xrays were taken and revealed three cactus needles stabbing through the dog’s small intestines causing a perforating foreign body. the doctor explained to the owner that the only way to even give the dog a chance to live is emergency surgery and gave an estimate for the $1500 surgery and a 50/50 prognosis. The owner’s response? Anger. Saying things to the veterinarian like: How could she be so cold and insensitive? She only wants money. If she REALLY cared about the dog, she would do the surgery for free. But no, she doesn’t care and is a terrible, cold hearted, unfeeling, horrid person who is MAKING her kill her dog when the dog COULD be saved if she would just stop being such a money grubbing Scrooge. I ask again, put yourself in the vet’s shoes. You have a dog that you know for the past WEEK has sat at home, starving, in pain, with a fever, feeling horrible and puking its guts up as three needles stab through it’s intestines. And what did the owner do? nothing. You know the dog is suffering, but you can potentially help and save it’s life! But what will the owner let you do? nothing. You know that had the owner brought the dog in right after it ate the cactus you could have used the scope and gotten the needles out for about $400. But they waited A WEEK. And according to the owner, this is all your fault. Her dog is going to die because of you. Talk about feeling powerless! You can’t even defend yourself! Your response. “I know this is a difficult situation, and I am so sorry.” But at the end of it all, you are the one that has to inject in the hot pink euthanasia juice knowing you have the skills and abilities to save this dog’s life, and instead, you must end it.
The final scenario that was occurring was an older dog that suddenly started limping on one of his legs. The owners thought, oh he must have arthritis, we will take him in and get some meds and he will be fine. The vet had already taken xrays before I got there and saw the bone cancer that was covering this dog’s humerus. Again, put yourself in the doctor’s position. You now have to tell someone that their best friend of 10+ years has cancer. The big C. Their options are either 1) amputate the limb, 2) very short term pain management (days) or 3) euthanize right now. You have to shatter their world and make people cry. You cannot offer any relief aside from euthanasia, which is no relief at all for the family. You get to be the bringer of bad news.
All of this occurred at 5:45pm… AFTER an entire day that started at 8am, with even more cases similar to these. This was one 15 minute section of time in a 10 hour long work day. No wonder veterinary medicine suffers from the highest suicide rate and highest addiction rate of any other profession. No wonder all veterinarians at some point suffer from what is called “compassion fatigue”. Unfortunately, the majority of people do not understand this about our profession. I cannot tell you how many times people have said to me, “oh you must LOVE your job! You get to play with puppies and kittens all day! Though, I bet it is hard when you occasionally have to euthanize something.” I just nod, and smile. What they don’t know is that I am thinking - yes, it is very hard. Those THREE patients I euthanized in the past 30 minutes were very hard (which happened on my overnight shift tonight).
I appreciate you if you made it this far!! All I am trying to do is help people to realize what the reality of vet med is… and what it is not. We are NOT in it for the money. We recommend tests and vaccines because we had 8 years of schooling that taught us what was best for your pet. We are overworked, emotionally drained, compassion fatigued, under appreciated/respected, and SEVERELY underpaid for what we do (because no amount of money is worth what we go through on a daily basis, *and side note, average salary for a veterinarian is $45,000/year and average student loan debt is over $150,000 :)* ). Yet, we wake up every morning and devote our life to your pets. We love them as if they are our own, we cry over them when they don’t make it, we work long hours and stay late working and reading to learn and try to figure out why your pet is sick. We talk to them like they are people and love them even when they try to bite us. We deliver pain, hurt, bad news, and encounter countless situations that we have no control over throughout our entire day. Our reward is internal… it is knowing that at the end of every day we have done everything that we can to the very best of our abilities for every patient we have touched, even if that means ending their suffering.
Thanks for reading :)
Lindsey Lane Verlander, DVM
4 year old female spayed CKCS presented with a one day history of ‘blood from the back end’, pain, and lethargy. There were normal stools the day before, and anal glands were expressed by a vet roughly 1.5yrs ago.
The dog was in a lot of pain, so we gave her some gaseous anaesthetic (isoflurane) before examining the area. As suspected, the right anal sac had ruptured, causing a massive entry wound. This is, understandably, very painful and can be very difficult to keep clean, so an anal sacculectomy along with a course of antibiotics would be recommended.
The owner had come to me during the weekend as their regular vet is not open on Sundays, so they opted for pain relief and oral antibiotics to tide them over until they can see their usual vet.