A Confession

My dog is fat. Not just a little fat...a lot fat. It's rather embarrassing. It does, however, make me sympathetic to owners whose also have fat dogs.

I know that plenty of clients are telling white lies when they recount how little Fido actually eats, or how much exercise he gets, or how he never gets table scraps. But with my own experience with owning a fat dog, some of them are telling the Gods Honest Truth. Some dogs are just fat.

It's a constant struggle to keep my kiddo from teetering over the edge from fat to obese. He's had every test known to man to try to find a "cause" for his fatty fatness. His thyroid is normal. I tested him for Cushings disease because his basic bloodwork and "clinical signs" were suggestive of it..nope, not that. I keep trying to find something to pin his fatness on something other than hypergroceriosis.

He gets measured portions of a prescription diet, he gets daily amounts of vigorous exercise, I'm the only person in the house, so nobody else is sneaking him food. And yet, he's fat. It's extremely frustrating. If you have a fat dog, I feel your pain.

There is one positive thing in all that fat...As I was caring for my fourth GDV patient this week (we're having a run of them for some reason), I was struck by the thought that I would hate to do a GDV surgery (or any abdominal surgery) on my own dog because I'd be wading through pounds of fat to fix him. Then, I reflected a bit on all the GDV's I've seen and realized I've never seen a fat dog with GDV. I did a bit of VIN research on the matter and it turns out thin dogs are at higher risk for GDV than fat ones (a bit of info that somehow got lost in my brain between vet school and now).

So, my not-so-little Fido, is at risk for all kinds of obesity-related disorders, but GDV is probably one I don't have to worry too much about. Of course, I probably just jinxed myself, by posting that (I'm furiously knocking on wood right now).

An Oldie...

Back when "Marley and Me" was in theaters, we had a bouncy, happy Golden Retriever present for eating a sock. It was not apparently his first experience with eating foreign objects.

Noting the breed, and the general boisterousness of my patient, I asked the owner if she had seen "Marley and Me" yet. The response I got was priceless. In an exasperated (but, obviously loving) tone, she blurted out, "Pfft! That dog was an angel compared to mine! This blockhead ate my stove!"

Beat that, Marley!

Quicked Nails

On a fairly regular basis, we get the "I was trimming my dogs toe nails and quicked one and it won't stop bleeding, what do I do?" phone calls. First we reassure the panicked owners that it's not an emergency and their dog is not going to keel over from blood loss, then we instruct them to go down to Walmart and get some Kwik Stop powder or a try packing on some cornstarch.

Here's a secret...the Kwik stop and/or cornstarch really don't work very well at all and what you usually end up with is a bloody cornstarchy mess all over your house. The easiest, least messy and most effective treatment you can do at home is to throw your dog out in the backyard for 30 minutes and wait for the darn thing to clot on its own. At the clinic we use silver nitrate sticks to stop the bleeding quickly and cleanly. They work really well, but most people don't have them laying around the house.

We actually had a dog in last night that had a legitimate quicked nail emergency. My first one ever. This fellow was trimming his dogs nails and quicked every single one of them. Bad. Almost down to the bone. It says something about the good nature of his dog that he (the owner) arrived in the ER without any major bite wound injuries. If I was the dog, I would have bitten the hell out of the guy!

This home toe nail trim cost the owner about $300 for heavy sedation with pain control for us to clean and cauterize every single toe nail on the poor dog, plus pain meds and antibiotics to go home on.

He's taking his dog to the vet from now on for toe nail trims.

Priorities

Last night I was presented with a young boxer suffering from dystocia. She had already birthed 1 pup, but after pushing for 2 hours, no other pups had been produced. She was painful and had a green discharge from her vulva. That's not good. There was a high probability the dog would need a c-section tonight, which I explained to the owner.

I recommended x-rays to help determine what the problem was to which the owner agreed. However, just before we took the dog back to snap some x-rays the owner pipes up with:

"How long is this gonna take? I've need to get to the bar."

Really?!

You might have to wait...

When I have an ER full of very sick animals (including one trying to die on me), and you bring in a pet that is suffering from a piece of poop stuck to his butt fur, you might have quite a wait on your hands. Getting all pissed off that you won't be seen this very instant and yelling at my tech is not going to get you seen any sooner. Take a seat and wait your turn, or better yet, Get the Hell Out of My ER!

I feel better now.

That sinking feeling...

When I got to work last night there was a record from a patient I had seen the night before sitting on my desk...that's never good (but can be something as simple as "Dr. you forgot to sign the record"). Then I noticed the sticky note on the record: "Please call the regular vet ASAP about this patient." Even worse. That sinking feeling started to set in, like a rock just landed in my gut.

That's when the second-guessing begins. "Oh shit." "I fucked up." "The patient is probably dead because I missed something." "The rDVM is going to ream me a new one for doing something wrong or not doing something I should have." "We're gonna lose a referring vet because I fucked up."

I immediately pick up the phone and try to contact the regular vet, hoping the dog is alive and I didn't fuck up too bad. She doesn't answer the phone. Shit. It does not make the night go easy when you have that hanging over your head all night. You go about you job as usual, but the feeling of unease and worry doesn't go away.

It was a weird case to begin with. It was a young dog that was suddenly lethargic and drooling. He'd had a history of bilateral chronic ear infections off and on his whole life. The regular vet felt a mass in his abdomen when she saw him. I didn't feel anything abnormal. The second-guessing starts up again..."Did I miss a mass or a foreign body?" "Could there have been a mass that got tucked up under the ribs by the time I saw him?" "I should have pushed for x-rays."

My major rule-outs came down to bilateral vestibular disease, ingestion of toxin or caustic substance, stomach ulcers or a foreign body. Toxin/caustic poison was low on the list because there were no lesions in the mouth. Foreign body and ulcers were low on the list because he just didn't seem painful enough and there was no vomiting. We did some bloodwork which was remarkably unremarkable. Then I didn't push for x-rays (beat myself up about that all last night). I was leaning toward bilateral vestibular disease. Vestibular disease is usually a straightforward diagnosis...you can read all about it here. It's a disorder of the vestibular nerve which runs through the inner ear and is usually (not always) not such a bad disease. It LOOKS like a bad disease because animals are generally quite symptomatic and come in unable to stand (or falling over when they try to stand), with a bad head tilt, vomiting and nystagmus. The cardinal sign of vestibular disease is the nystagmus - the eyes jerk back and forth causing motion sickness. It's usually "unilateral" meaning affecting one side of the body. This dog didn't have nystagmus. I presumed this was because both ears were affected and they sort of cancelled each other out.

But I wasn't 100% sure...

More second guessing...

I convinced myself it was vestibular. I treated the dog for inner ear infection and gave him some antinausea medications and sent him home. I cautioned the owners that I could be wrong, so please come back if there are any concerns, but I really think the ears are the problem.

Then last night I saw the note. Crap.

I poured over postings on VIN reading about bilateral vestibular disease. I found a couple of videos on VIN showing cats with bilateral vestibular. My patient wasn't doing the same things as those cats AT ALL! Double crap.

Got ahold of the regular vet this morning. Braced myself to be ready to be reamed a new one by her. Turns out the dog is fine. Probably was the ears. Probably wasn't a mass in the abdomen (we decided it was probably just a very full bladder...abdominal palpation can be a bit ambiguous in dogs and cats sometimes). We both agreed it was a weird case.

The dog is alive and well. The regular vet is happy. My stress levels have returned to normal. I can sleep well this weekend.

Apologies for the long lapse...

I'll try to not do it again...got caught up in my non-veterinary life. Just bought my first home! Yeah! I'm mostly settled in and am loving it, though after the down payment and all the closing costs, I don't actually have enough money left over to furnish it. So far I have a bed, a chair and a table (that doubles as an eating space and desk). The rest of it will come with time and lots of Craigslist browsing.

Back to veterinary-related stuff...

I recently had the opportunity to participate in our legal system when I received a subpoena to testify as a witness for the prosecution in an animal abuse case. Fortunately, such cases are not common here. This was a pretty straight-forward case of a friend (I use that term loosely) of a dog owner that in a fit of pique toward the owner, beat the crap out of his young pup. The dog owner was a pretty big fellow that I wouldn't want to trade fisticufs with, which I suppose is why the friend took his aggression out on the dog, rather than his rather beefy owner. I was called to testify because I was the vet that treated the dog.

Just to allay any concerns...the dog suffered some mild brain trauma, but recovered fine.

Anyway, I get called to the DA's office so they (the DA and the cop covering the case) can go over my findings and treatments and to prep me for the witness stand. They were very concerned that I might be nervous on the stand ('cause I guess a lot of people are) and were trying to give me all sorts of tips in case my brain spazzes out or something. It was cute. I'm like "Dudes, I have people yelling and screaming at me, critters trying to die on me everyday. My job requires the ability to remain calm and actually use my brain in stressful situations. I think I can handle a defense attorney in a controlled courtroom situation, especially when I'm not the one on trial." My little speech didn't deter them from trying to give me more tips. As it turned out I never had to testify since the bad guy plead guilty to Aggravated Animal Cruelty (a felony in my state). He has a nice jail cell now.