Saturday, 16 January 2016

I Have A Curse

Maybe it's "beginner's luck," but my cases all turn into wacky, that-never-happens, no-one-has-seen-anything-like-it sagas. I'm not complaining, but it's uncanny. I've had to research things that the other vets have hardly seen a handful of times in thirty years of practice. I've had straightforward cases develop bizarre crazyland complications. Last year, my boss told me I'd seen more weird stuff in two months than he'd seen in two years.

Here's a selection of the weird and wonderfuls I've seen...
  • Great Dane with Lyme disease who came back a week later with a severe immune-mediated vasculitis (his leg was a water balloon).
  • The same week, a cat came in for a recent "swollen foot." Sounds like a cat bite abscess, right? Nope. Huge elbow mass full of joint fluid. Maybe a synovial sarcoma?
  • Also that week, a young cat brought in because he was having trouble breathing. Turns out he had acute anuric renal failure, for absolutely no reason we could figure out, and didn't respond to treatment. Died that day, nothing to do with the breathing.
  • My first month in practice I encountered a dog with megaoesophagus, which is a rare condition.
  • My first month, I also prescribed routine ear drops for an ear infection--a situation that happens on an almost daily basis. But this dog went death in both ears immediately after starting the drops. The owners were so mad at me I could barely talk to them. Has never happened before in this practice with any ear medication for any of the other vets.
  • My boss saw a cat for a cat bite abscess and I ended up with the recheck the next week on his day off. He assured me it would be routine. Turned out to be in massive acute liver failure and spent the day on oxygen support because it could barely breathe.
  • My first blocked bladder cat was a female with five struvite stones at least the size of your thumbnail. My boss has never seen as many large stones in a cat in his whole career.
  • I saw a cat with nice owners a few times for small issues, then he came in a month later, on death's door, with a stomach full of blood. He was an indoor, only cat with no medications and no access to anything unsavory that we knew of.
  • I had an ongoing saga with a cat that wouldn't really eat for weeks to months for no discernable reason. The owner is a little batty, and wouldn't let us do the full nine yards with regard to treatment, but still cicled around with this cat for ages. Weekly rechecks, repeat blood work and imaging, no response to any medication--and we must have tried the whole pharmacy.
I'm sure many more are on the horizon. They especially like coming in when I'm by myself, like Saturdays or in the evening on my late day. There have been a lot of panic texts to my boss these past six months.

Thursday, 14 January 2016

HO HO Hypertrophic Osteopathy

Did you know that some lung tumours manifest as extra bone growth in the paws? That is, the first sign that we see is lameness and swelling of the legs, and when we go hunting, whoa hey there's a lung tumour. Some weird endocrine paraneoplastic response. It's called hypertrophic osteopathy.
It's still close enough to Christmas for me to use that in the title, right?
From google:

Tuesday, 12 January 2016

First Bird In-Patient - Patched Up A Macaw

Our first injured bird came in, and it went well! There is a nearby bird rescue, and one of their Military Macaws got attacked by his cage mate. He was missing a piece of his eyelid and all the feathers over his tail, plus had some various cuts and bruises. He was quite gentle to work with, however, and I daringly admitted him to the hospital. Our first avian admit!

I'm not great at wound management in general, even in dogs and cats. I tend to fumble through, with lots of direction from the other vets. For some reason I have a difficult time understanding the concepts, even though wound healing was drilled into me in vet school. Something about making the connection between lecture material and physically working with a wound right the hell in front of me has a hard time inside my brain. So, naturally, our first "sick bird" was a wound. But hey, could have been way worse!

I've read plenty about intranasal sedation, but when I was on Wildbase, I never saw it done. So I cruised VIN, checked my Avian textbooks, picked a dose, and went for it. Boom, midazolam and butorphanol right in the nostrils. No one else had seen it done before, either, so then we stood around with the lights dimmed waiting to see what happened. After about five minutes, we had a pretty snoozy parrot! The other vets were impressed.

I flushed out his wounds, applied some silver sulfadiazine and some Tegaderm, and that was pretty much it. It turned out I couldn't do much with the eyelid, though I wasn't sure until we sedated him (and the owner didn't care about cosmetics). Sent him home on antibiotics and meloxicam, and he's doing great.

Here's his good side.

Saturday, 9 January 2016

My First Avian Clients Were A Piece Of Work

I decided I want to be an avian vet. In vet school, this idea was something like, "I want to be able to see a bird and not be afraid of it." So many vets out there refuse to see them, I figured, hey! There's a niche here waiting to be filled. So I studied our avian lectures very closely, I took avian electives, I got some experience at an aviary. When I realised how big a deal avian medicine can be, it hit home that I couldn't half-ass it--I had to know about birds, which is why vets who don't see a lot of birds often won't see any--so I also got my butt down to ExoticsCon, bought some textbooks, and started some focused studying.

The only thing left to do was, well, to actually start seeing birds. It's the only way to learn, really, especially skills like handling, physical exams, and blood draws. And answering the strange questions I never expected anyone to ask.

My sparkly exciting future full of our feathered friends dimmed a little bit when I encountered my first bird clients. Okay, they're technically the second--the first was a necropsy on an endangered duck, which I will definitely write about one of these days. But they were my first companion bird clients, and companion birds is really what I do. And boy oh boy, I definitely had a moment of, "Is this what bird people are like? I don't want fifty clients like this."

They found me by searching the AAV website, of which I am a member. This was before the newspaper article for our clinic announcing I was seeing birds, and maybe even before we got it onto the clinic website. These people managed to get onto a website mainly used by vets and look up where I work. This was slightly alarming because they kept referring to me as being "boarded" by the AAV. Er, I paid the association a membership fee and they send me a journal. Being boarded is a huge, huge ordeal involving giant scary exams, after which you are a specialist.

Anyway, they have a whole bunch of birds. The first one they brought me was a macaw. Like, pretty much the biggest companion bird there is. For my very first avian exam in real life, ever. EVER. And with technicians who hadn't handled a bird in over a decade. To top it off, these are pushy, anxious people, so their birds are pushy, anxious birds, and there's nothing as much fun as having a huge macaw lunge at you any time you get close. The owners were not impressed that I seemed "intimidated" by the birds. I wasn't, but when you've only been in practice for about 5 minutes, you don't have the hardened steel to not flinch backwards when a beak the size of your hand is snapping at you.

Once we got past the introductions, one of the very first things these people said to me is how Harrison's bird seed is actually really bad for birds and vets shouldn't be recommending it. They read it online. Luckily, they said this about two seconds before I was about to tell them to try Harrison's bird seed, so I avoided that argument. They are very proud of how rich and varied their birds' diets are--lots of fresh fruit and veggies, and seeds, and rice, and quinoa, and pasta, and... wait what? I tried to explain that a likely reason the feathers are ratty, and the stool is loose, and the beaks are flaky, is because they have (wait for it) an imbalanced diet, and I firmly suggested they at least increase the percent of formulated pellets. This lasted for all of two seconds of course, because they've been in a second time, and again proudly explained their home-made diet to me, which has zero pellets now.

Okay, so I'll never convince them to change the diet. I won't bother arguing. They also wanted me to check the loose stools, like I mentioned. I did a full faecal exam and actually came up with a diagnosis. Put up some meds for them to try. Turns out they went home and researched the drug on the internet, decided it's too dangerous, and it was far riskier to give the really-good-for-diarrhoea antibiotic than to let the birds keep having diarrhoea forever.

I spent at least an hour with these people, maybe even an hour and a half. I gave the birds tons of time to get used to my presence, the sight of the towel, me patting them, before I even started the exam. I talked with the owners about all their crazy "I read such and such online" questions. I explained everything about diet, and gave them handouts with information from trusted veterinary sources, as well as a ton of free samples of pellets and diet conversion products. Then they bitched about the bill, saying that for someone so inexperienced it should have been a lot less. Maybe, oh, $30.

They said they'd go back to their other vet. Whose history, by the way, was two, two-word lines: "[Date] Sexed - male." and "[Date] Nail trim." I was secretly relieved, because I knew it would be a headache to ever get these clients to comply with any veterinary advice.

Alas, it didn't stick. They came back a month or so later, with some more birds. This time around, they wanted me to examine a new bird, so they wouldn't have to keep it in quarantine/isolation for the full 30 days. They didn't want to do any of the bloodwork or viral testing that is recommended, and balked at the price of a hundred or two hundred dollars. They wanted to know why I couldn't just give it a "clean bill of health." I explained about asymptomatic carriers of disease, but they decided that chlamydiosis is a severe illness (one of them had caught it from a bird before), so if the bird had it, they'd be super sick by now.

That bird was strikingly sweet, and had excellent feathering and body condition. Even the owners commented on how much more quiet and docile she was compared to all their other birds. Turns out they'd only had it a week. Sigh. Can't wait to watch it slowly get more aggressive and poorly every time I see it...

Friday, 8 January 2016

You Have A Cold? Time For GDV Dog To Come In When You're By Yourself.

Yesterday, when I left the house, I felt normal. By the time I got to work, I had one of those, "Oh, the air is a bit dry" sore throats. Then I proceeded to get sicker by the hour. Since I hadn't been sick in the morning, I wasn't prepared. At home I have a cornucopia of cold and flu remedies, but at work all I had was tea. Lots and lots of tea.

It figures this would happen on my late day, when the clinic closes at 8pm. Things went pretty well, considering. Most of my exams were new pets adopted from the shelter, getting their free exam. I speyed a shelter cat. Dental on a dog that didn't need any extractions. For the evening appointments, one showed up super early, one was just a booster with no exam, and we knocked it out of the park.

Yay, maybe I can get home somewhat early and then take some NyQuil and pass out!

Ten minutes to seven, phone call. Young dog that has been severely vomiting all day. May have eaten sewing fabric or needles. Hmm, doesn't really sound like something that I want to wait overnight.

I knew it was going to be a long haul as soon as they arrived, because this dog was a big labby thing that was going crazy. All over the place, jumping, panting, anxious, wouldn't sit still. There were only three of us in the whole clinic, and one of the technicians is recovering from broken ribs so can't handle any animals. So it was two tiny young women against big anxious dog. When we finally managed to get an xray... Oh shit, that looks like GDV.

I decided to call the emergency clinic to see what they recommended. I had the brilliant plan to email them the xrays. Turns out none of us knew how to actually log in to the email account.

Long story short, it wasn't actually GDV, gave it some meds, and the dog got better overnight. They canceled their recheck appointment today, along with the other... three or so appointments I had. So after the handful of morning appointments, everyone kind of shuffled me out the door to go home and rest.