Monday, November 30, 2009

Lucy is #100!!

Lucy was normally a feisty and trouble-making tortiose shell kitten. Well, yesterday she had the trouble-maker part down pat. Her feisty personality was toned way down, though. She had vomited the day before, a piece of what looked like gift-wrapping ribbon. And there was blood in the vomitus. If that had been all, and she had gone back to eating and tormenting her brother and all, well, that would have been that. But Lucy's mom just had a feeling about her, and I have learned never to dismiss a mother's intuition. She brought her in first thing in the morning-and I am glad she did. Lucy's usual glossy hair coat was oily and rough-she wasn't grooming herself. Her gums were tacky and dry-she was dehydrated. And when I palpated or felt her abdomen, she became very tense and painful-different from the normal-"don't do that, I don't like it" reaction most cats will give me. It might be a subtle difference, but like her mom, I knew it when I saw it.

Because of her history of vomiting up what looked like ribbon, we decided to take some radiographs of her abdomen right away. Now, for most patients with a little vomiting or gi upset, I don't usually jump right to x-rays. They are expensive, and by far most pets are going to get better with a little tender loving care, maybe a fast, some fluids, bland food, etc. But remember her mother's intuition? And remember her painful abdomen? And remember she vomited blood and ribbon? Those symptoms all added up to trouble-and I wanted to be ahead of the game with Lucy's diagnosis. I'm glad we took the pictures.

Lucy's radiographs showed a whole lot of "stuff" in her stomach-lots of very distinct lines all packed together-nothing readily identifiable. Her owner said she hadn't been fed since the night before, (and she didn't know if she ate then or not-she does have another kitten in the household.) Lucy hadn't had any breakfast, so she shouldn't have had anything in her stomach at that time. Since I couldn't identify just what it was, but knew it shouldn't be there, and because that meant a pretty big next step-surgery-I wanted a second opinion on the films.

We have all of our x-rays read by a board certified radiologist-I learn a lot from him and it is a lot of comfort to have that second set of eyes when I'm just not sure of what I'm seeing. Our local veterinary reference laboratory provides a courier service for the films themselves, (I haven't made the 70+ thousand dollar investment in a digital system yet...) picking them up and delivering them to the radiologist's office where he interprets the films, faxes us a copy of his results, and sends the films back via the same courier service. This is a very handy and speedy service, but still takes a day or two at best. We can occasionally arrange for "stat" pick up and delivery of films, but there is a considerable extra fee involved, and still some delay. Since I was worried about the liklihood of imminent surgery for little Lucy, I asked her owner to hand carry the films to the radiologist's office herself, saving the fee and resulting in much faster results. Lucy stayed with us, and so did George, her big brother-more for moral support for HIM. He couldn't bear being seperated from her!

All this worked out very well. In about an hour the radiologist gave me a call and concurred: the radiograph findings suggested we should do a "peek and shriek" surgery. In proper medical terms, an exploratory laparotomy. I like "peek and shriek" just fine. They are usually quick and we usually find some pretty impressive things to "shriek" about in these surgeries-and Lucy's was no exception.

We called Lucy's mom and told her what she was already suspecting-Lucy would be going to surgery right away. We called a few other owners to rearrange the schedule-those with "routine" appointments for things like vaccinations had no problem resceduling for another day. Others with ill pets, just not as critical, got moved to a little later-all knew that if it were their pet needing the emergency attention, they would be first in line. That's just how we do things here, and everyone is usually very understanding.

I have to mention here how very lucky Lucy is to be owned by such good humans. Not only did they recognize her signs of illness and bring her right in, they also accepted the responsibility and need to care for her, making big sacrifices during this holiday season so they could provide the care she required. We all know that isn't the case with all of our animal friends, especially in these difficult economic times. Hurray for Lucy's humans!!!

Schedules were rearranged, the staff swallowed some pizza I got for their lunch and off we went to surgery. Lucy did great, and so did her team. She was anesthetized and prepped for surgery, and I was in the surgery room with her in record time. It didn't take long to find her problem. Her stomach was the size of my fist, (That's pretty darned big for a 9 pound cat!) and although outwardly it looked just fine (no signs of perforations or necrosis, thank goodness) it was rock hard. I ran through the rest of the gastrointestinal tract and found it was completely empty-whatever was in the stomach had prevented anything from entering her intestines for quite some time.

After ensuring that the stomach was the sole problem area, I performed a gastrotomy-an incison into the stomach wall.
The contents were pretty impressive-wads of what appeared to be plastic strips and elastic bands-hair bands and maybe even a small bungee cord. And yes, there were many pieces of colorful ribbons, too. Lucy had been collecting these goodies for quite some time.

We saved all these treasures to show her owners-after all, they were paying good money for retrieving them! Hopefully they would be able to identify them-and then be able to "Lucy-proof" their home a little better than they thought they were. Her incisions were closed up, Lucy was given some good pain medication, and she was tucked into her recovery kennel, nice and toasty warm. She was a bit slow to wake up, but there was no rush. We monitored her carefully, and by the end of the day, she was doing just fine. She even ate a couple fingers full of food! We set up some nurse checks and I put my web cam on her so I could monitor remotely. She got a little over heated with all the heat lamps, heated kennel and heated rice bags, so those were removed during the night, but otherwise, everything went smoothly. Lucy had another dose of pain medication this morning, and soon after she began eating like a pig! She wouldn't let poor George any where near the food dishes. She must have been starving for actual real food-hair bands don't have much nutritional value.

Lucy's owners came this morning to pick up her and her brother-the house must have been awfully quiet without those two last night. We went over her care instructions-I don't usually consider gastrotomy patients "out of the woods" until about 10 days or so post-op. That would give the stomach incision plenty of time to heal and digestion to start up again. If any leakages were to occur, infection would become obvious during this time. All in all, I was quite pleased with how she did, and expect her to recover just fine. Now it is up to her humans to keep her away from those darn enticing stringy things. My own cat, Stella, has an addiction to curly ribbon-she can just smell a package wrapped with the stuff when it enters the house and is immediately drawn to it, chewing frantically unless I intervene. It is weird just how much certain cats love to chew on things like this-ribbon, string, yarn, tinsel, dental floss, and yes, hair ties. If you don't know what your cat's predilection is for these things, don't take a chance! Keep them in drawers or cabinets or in covered bins. Surgery is no fun for any one. (Well, I actually DO like these types of surgeries :) "A chance to cut is a chance to cure." In Lucy's case this adage is particularly true.

Wow! Lucy's story makes 100 blog entries! That is quite a milestone, especially since I took the last 3 months or so off. I hope you have had some fun reading about the various patients that have come and gone in our busy little hospital-maybe were grossed out by a few stories, laughed at some, shed a tear or two at others. I tried to always add a little "educational" aspect to most of my blogs-hopefully teaching fellow pet lovers some new things about their friends, reminding you of situations to be aware of or just exposing you to an aspect of veterinary medicine that you might never have considered before. Some veterinarians are called upon to do some pretty amazing things-from realigning the broken bones in the leg of a puppy accidentally stepped on by the playing children, to stuffing the intestines of a "broken" spider back in his body and super-gluing him closed. Some of us who enjoy surgery might get to repair a torn ACL on a rambunctious lab or pull hair ties out of a kittens packed stomach. We occasionally get to diagnose rare or exotic illnesses, and the outcomes may not be good-but hopefully we learn from them, too. With all this knowledge and technology at our hands, we still have a "few" limitations. (Ha ha! I wish it were ONLY a few!) But I was referring in this instance to a limitation I have often wished we didn't have-we still aren't capable of installing zippers into the bellies of patients who repeatedly eat things they shouldn't eat.


Thursday, August 27, 2009

A Big Dog With a Big Problem

Kodi was a BIG dog-a gorgeous 120-pound Malamute- who had a very big problem-his kidneys weren't working like they should. For him, this meant the waste products of every day metabolism that build up in the bloodstream just kept rising, unable to be filtered by those failing kidneys. Now, Kodi wasn't an old dog as you would have expected. Older patients get things like organ failures-they just wear out after years and years of use. Sometimes they get cancer in those organs. This just wasn't the case for Kodi-he was only 4 years old. As we attempted to treat Kodi for the obvious problems resulting from his kidneys not working, we also had to go on a hunt for possible causes of their failure-or we might not be able to stop it from happening again.

Since kidneys are a filtering organ, anything that travels in the blood stream and accumulates in the kidneys could potentially casue those organs problems. Drugs like non-steroidal anti-inflammatory medications can do this, especially ibuprofen, a drug really meant for human, NOT canine use. Other medications humans routinely take could have renal toxicity problems in dogs, but Kodi's owners were fairly certain he didn't have access to anything like that. They hadn't given him anything as some people do, "just to make them feel better" before resorting to a veterinary visit. We couldn't think of any plants or yard products/chemicals he could have eaten, and they hadn't changed their anti-freeze in their cars recently. Anti-freeze is a well known kidney toxin.

There are, of course, primary diseases of the kidneys themselves-infections like pyelonephritis which can develop from bacteria that travels up the urinary tract from the bladder to the kidneys when a pet has a bladder infection, often unnoticed by owners. The blood work we did on Kodi did not indicate any infection in his body right then, but it was still a slight possibility.

Leptospirosis is a bacterial disease that can affect the kidneys of dogs, as well as humans. Wild critters such as possums, racoons and rats can be the carriers, spreading the organism through their infected urine. The disease can be serious for both humans and animals. In people, the symptoms are often like the flu, but sometimes leptospirosis can develop into a more severe, life-threatening illness with infections in the kidney, liver, brain, lung, and heart. Because we had put many of the other possibilities for Kodi's kidney problems lower on the differential or "rule-out" list, leptospirosis worked its way higher up the list. Testing for the disease is done via a blood sample, but results often take 10 days to get back. Since the treatment for the leptospirosis bacteria itself is done with antibiotics, we decided to start Kodi on these right away rather than wait for the test results to come in.

Leptospirosis is one of the "big" diseases we usually vaccinate at-risk dogs for every year, but unfortunately the vaccine does not provide 100% protection. This is because there are many strains (types) of this bacteria, and the vaccine does not provide immunity against all strains. It is important to get your pet vaccinated again even if it gets leptospirosis because it can still get infected with a different strain of leptospirosis. Kodi was vaccinated each year for 4 different strains of lepto, but his test came back positive for another strain, one for which a vaccine is not available. It was a good thing we had started him on antibiotics when we did. when we got the test results back, we also started his house mate, Kiona, on a prophylactic course of antibiotics. She wasn't showing any symptoms of the disease, and we certainly wanted to keep it that way.

As mentioned, treatment for the leptospirosis bacterial infection is antibiotics, specifically those in the penicillin family. These will arrest the on-going infection, but dogs can remain carriers of the disease unless a second antibiotic from the tetracycline family is used, often for 6 weeks, to break that carrier state. Kodi was initially put on injectable ampicillin since he was so nauseated and anorectic from the kidney disease that resulted from the infection. And this was the big problem: we had a handle on the disease and could get it treated, no problem. But the damage it had already done to Kodi's kidneys was severe-he was hospitalized multiple times, once for 4 days in a row for 24 hour a day IV fluid therapy in a attempt to diurese his blood and get those kidneys working again. It never worked. His owners were terrific. They did everything we asked of them, bringing him in for testing, for hospitalization and treatment despite the considerable time they had to take off work and expenses they incurred. He spent a lot of time with us and in the emergency hospital when we weren't available.

We really expected such a young, big, strong, dog to turn the corner any time and make a full recovery, but it was not to be. Kodi's initial bloodwork showed just how poorly the kidneys were doing, and his first retesting of their values showed good improvement. Kodi was given very aggressive care, including those antibiotics, fluids, anti-vomiting medications, prescription renal diets to require less work on the kidneys while providing good nutrition for healing, antacids, appetite stimulants, phosphate binders (phosphorus levels go sky-high in kidney failure patients, making these patients very weak and wobbly, and Kodi was no exception)-you name a drug in our pharmacy and he probably was on it at one time or another! Subsequent testing showed no changes in those kidney values, and his phosphorus levels worsened, making him even weaker. His owners were reaching their limits of what they wanted to put him through, and frankly, what they could afford to spend. When Kodi finally became painful-his kidneys evidently swollen and tender-he was crying out as only a 120-pound Malamute can-his loving owners made the choice to end his suffering and said goodbye. It was a terrible tradgedy-his owners did everything right, loved him, fed him right, provided him with good preventive health care-and it just wasn't enough. They unselfishly did the right thing for him that weekend, as hard as it was on everyone involved.

Kiona is still symptom-free, and we fully expect her to stay that way. We had a little scare when one of out veterinary technicians became ill this week and made sure to alert her physician about her exposure to leptospirosis. In fact, we were required to report Kodi's case to the state veterinarian, that's how serious this disease is.

Definitely get your pet vaccinated for leptospirosis (the "L" part of a typical DHLPP vaccine) if he or she is at risk, and do your best to control the rodent/small animal population to minimize their urine in your pet's environment. Leptospirosis is out there, but is not a very common disease, thank goodness. If your pet has been confirmed by your veterinarian as having leptospirosis, don't despair. Early, aggressive treatment usually brings about good results. Kodi's case was rare and tragic.


Monday, August 10, 2009

Making Herself Right at Home

So, the picture is a little blurry, but that is because little miss Raena was moving pretty darned fast. That big silver disc she is on is actually her exercise wheel, a pretty great design, considering most of the ones you usually see for rodents are made of open wire, and an open wire wheel caused Raena a huge problem a few years ago. She got hung up in it somehow (she wasn't telling exactly what happened) and broke her tiny little leg. We tried to fix it, but rodents aren't known for being the best patients when it comes to injuries like that, and Raena the chinchilla was no exception. Chewing at wounds and suture lines, and not understanding the meaning of "rest" or "taking it easy" until the bone could heal meant numerous complications, and she ended up having her left hind leg amputated. Not that you would ever know that today. She may have a goofy little swing to her gait, but when she gets going on her nice solid wheel, she looks like a pro! And boy, is she fast! We had her out in the living room the other night just to see her scamper around. When it was time to put her to bed-ha! it was crazy trying to catch that slippery little varmint! It really does my heart good to see how lively she is-don't even dare consider this girl "handicapped." A 3-legged chinchilla is just the most natural thing in the world, at least it is in a vet's home!

My husband Michael and I lost our first chinchilla, Edgar, last year. He was over 15 years old-quite a distinguished old man, and such a wonderful little pet. I don't think we realized just how much we had missed him until we learned that Raena's owner was asking about finding her another home. My hospital manager, Cori, had owned one of Raena's babies at one time, and she would have made a great home for her. But she has a very happy chinchilla already, and she didn't want to risk upsetting the balance of his life by adding another critter right now. I jumped at the chance to add Raena to our little family, and she came home with me last Friday.

You would think she would take some getting used to her new situation, needing some time to figure things out and all but, no, not Raena. She never missed a beat, jumping out of her travel carrier right onto her exercise wheel and going for a short run right when she arrived. Then she hopped over to the side of the cage and took a raisin from Michael-he was thrilled! It was one of Edgar's favorite treats, and now you can be sure she will be spoiled rotten by her new "dad." Raena wasn't even phased by the cats who came running over to see who was taking occupancy of the great big cage in the living room-they were pretty perturbed it wasn't for them! Anyway, Raena didn't even bat an eye at those natural predators, or maybe she was batting her eyes, winking and flirting, more like teasing those cats who are easily 6 or 7 times her weight!

Chinchillas are members of the rodent family, actually closely related to porcupines if you can believe that!, but also related to guinea pigs.

Yes, chinchillas were originally bred in captivity for their pelts-it IS wonderfully luxurious and beautiful, but it seems to me it would take an awful lot of those little guys to make a single coat! Current fur colors we see include white, silver, beige, and black. The chinchillas who were lucky enough to have lower quality fur were sold as pets, although some were used as research animals. That is how I got my first chinchilla, Edgar-he was losing all of the fur on his body, not exactly what they wanted in the fur-coat business, thank goodness! He was a wiley little dude-he grew a gorgeous thick silver coat after he came to live at our home and was no longer at risk of being made into a coat.

Chinchillas originated in the barren, mountainous regions of Peru, Bolivia, Chile and Argentina-particularly in the high altitude Andes mountains. The first known chinchilla ranch was founded in Chile in 1874 in Vallenar by John Murry, an English member of the famous scientific expedition "Challenger." In February 1923 an American mining engineer, Mathias Chapman, brought the chins to North America. He was in charge of several mines in the Andes and that is where he was introduced to the chinchilla. He took an immediate liking to the little guys and hoped that he could take a few of them home to California as pets. The export of chinchillas was illegal, however, he eventually persuaded the authorities to permit him to take eleven chins with him back to the States. Eight male and three female Chinchilla Lanigeras. He brought them down from the mountains and arranged passage on a Japanese freighter. And the story goes, (although this is almost certainly apocryphal) that all the chins in North America are descended from Chapman's.

In general, chinchillas are very friendly and clean little pets, and compared to most pet rodents, have very little odor. They can be quite shy and high-strung and therefore easily frightened, so they aren't the best pets for small children. It can be difficult to house multiple chinchillas in one cage, even in larger cages, especially if you have a more aggressive female chinchilla. Breeders and pelters have an interesting arrangement for their habitats to avoid "disagreements." They will create polygamous colonies with one male having access to five or so females maintained in separate cages. The male has a tunnel along the back of the females' cages which enables him to enter any cage at will. The females cannot pass through the tunnel because they are fitted with light-weight collars that are just a little wider than the cage opening.

Chinchillas are best housed in large, wire-meshed cages for proper ventilation, with or without a solid floor. They need some sort of enclosed nesting box to sleep in. They tend to be nocturnal creatures, spending a lot of time running around, eating and playing while YOU are sleeping-so be sure to oil that squeaky exercise wheel! Wood cages aren't a good idea because chinchillas are constant chewers, and pretty quickly your nice wooden cage will be a pile of saw dust! Ideal environmental temperatures are around 60 to 75 degrees F.

Raena has been fed a very good, balanced diet-but that isn't the case for a lot of the pet chinchillas we see. In fact, improper nutrition and/or husbandry (housing and care) are the most common causes of health problems in our little rodent and other small pets. She gets a pelletted chinchilla diet, although not all pet stores or feed stores will carry this. Using a standard rabbit or guinea pig ration is OK temporarily. Chinchillas like Raena are really cute when they eat, tending to pick up each pellet with their little hands, but they can be pretty messy, too, throwing a lot of pellets around the cage, so there can be quite a lot of waste. Raena has been pretty neat about her eating habits so far.

Grass hay is an important part of a chinchilla's diet as it adds fiber, important for proper digestion and teeth wearing (chinchilla's teeth grow constantly through their lives so need to be monitored for problems associated with overgrowth.) Hay also just gives these little guys something to do. Bored chinchillas often start to "barber" or chew on themselves, and many become bald as Edgar almost did. Alfalfa hay has the wrong calcium/phosphorus ratio for proper chinchilla nutrition, so should be avoided. Any hay fed to them should be clean with no evidence of mold, insects, or wild rodent contamination.

I mentioned earlier that Raena loved the raisin that Michael gave her. Dried fruit and nuts are great treats for chinchillas-and these little guys really do look like they are just relishing those treats! Fresh veggies are great, too, but all these treats should only be about 10% of the total diet. Because of their original habitat, dry, barren mountainous regions, chinchillas aren't used to taking in lots of fluids like what is found in fresh produce. They will likely drink much less water if they are offered these fresh treats, but their urine output should remain about the same. Be sure to monitor this for any changes or problems. Raena has a wonderful plastic corner box which she uses as a litter box. I just take that out and rinse it out every other day or so-it really cuts down on the need for an over-all bedding change in her cage. Pretty cool, huh?

One unique part of chinchilla husbandry is the need to offer them a dust bath a couple of times a week. Raena LOVES hers! She takes her dust bath in a little plastic box, big enough for her to twist and turn and spin all around, covering herself from head to tail with the lightly colored powder. When she is done all you can see are her two little eyes peeking out of all that powdered fur. The dust is actually a finely ground volcanic ash, and it serves to keep that wondeful fur clean, oil free and over all well groomed. I think it is just plain fun for them to spin around in the bath! Here's a good You-tube video of a chinchilla enjoying his bath:
Chinchilla Dust Bath
I don't leave the bath in the main cage all the time or it gets used as a litter box...and then it isn't much good as a grooming aid.

Raena is a pretty tame chinchilla, but she still doesn't like being handled all that much. In general, chinchillas are usually easy to handle and rarely bite (although any little critter can if agitated enough.) More likely, they might just urinate when they are annoyed about being held-so watch out! You also have to be gentle when handling chinchillas due to the possibility of 'fur slip." This is a sudden shedding of the hair coat in a patchy way that occurs when it is grasped or handled roughly. I haven't ever seen this happen-and I hope I don't! Doesn't 'fur slip' sound awful? As with any animal, just be gentle but firm when holding or restraining a chinchilla to avoid injuries to you or them.

The average life span for a pet chinchilla is 8 to 10 years, but there have been reports of some reaching 18 years! Raena is 6 years old right now, so she should have a good long life ahead of her-I sure hope so! She has already brought a lot of joy to our home, and I am so very grateful to her first owners for letting us adopt her into our family. I have been playing around with how her name is spelled, and even if we should keep her name as it is since it is so darned close to my own. I found several different definitions for her name, including "queen," "pure," and "song." We'll see how things work out. For now, our "pure little song queen" is working her way into our isn't taking long to accomplish that!


Sunday, August 2, 2009

What More, Verbal Dog?

Regular readers of this blog (and anyone who knows me AT ALL) know all about Verbal. She has been my constant companion since she joined my life over 11 years ago, an adorable, 4-week old yellow puppy. This tiny, broken thing was presented to the hospital where I was then working by a supposed "breeder." I use the word loosely-what kind of breeder would cross a Golden Retriever with a Yellow Lab, and do absolutely no pre-breeding health or temperament testing on the parent dogs? As much as I love this dog of mine, I have had numerous times called her "my genetic disaster," referring to her terrible hip and elbow dysplasia, her numerous bouts with cancer (yes, debatable whether genetically linked or not) and her, at times, questionable temperament.

Anyway, this little puppy had been attacked by her daddy dog-evidently she got too close to his food dish and he mauled her. 4 weeks old and he broke her jaw and ripped her tongue off. The "breeder" brought her in to be euthanized-they couldn't justify putting any money into this one puppy when they had 8 others at home, and it was pretty obvious how they felt about spending money on veterinary care.

Well, I would have euthanized the dog that did this to the pup in a heart beat-what would stop him from turning on a child someday? But there was no way I could end the life of this innocent little ball of joy, wagging her tail despite the terrible pain she had to be in. My husband and I had just happened to purchase our first home literally one month prior to meeting this wayward puppy, and we knew that adding a dog was in our future.....Can you see the big word "sucker" tatooed across my forehead? Well, there's worse things, for sure. We had the owner sign over the rights to the puppy, and we did surgery to fix her up right then.

Her lower jaw was broken, so we placed a pin through the length of it. Her tongue was reattached, and we could only cross our fingers and pray that it would be functional after such a dramatic injury. To this day, she has a huge scar on the back of her tongue, and when she yawns, her tongue curls up, almost touching her right ear. I doubt it has much feeling on that side, so accounts for even more dribbling than usual after drinking water (but what labrador anywhere drinks neatly???) It isn't perfect, but at least she has a tongue, and that goofy sideways grin gives her even more character than the usual smiling, happy water dog that she is.

4 weeks is awfully young to wean a puppy from its momma, but this just wasn't a normal situation. We did our best choosing some pain medication for her, but were limited due to her age. It didn't seem to matter, though. She was up and eating that first night after surgery, and was carrying a frisbee that was bigger than her later that week. Eating and carrying something, Frisbee, tennis ball, stick-SOMETHING-have been THE themes of her life ever since! She was our first (and so far only) dog in the family, but not the first pet. Flake was our "top dog," even though she happened to be a Maine Coon cat. She was bigger than the puppy at the time, and even though not exactly thrilled with the new addition, handled her just fine. The curious puppy couldn't help bouncing up to the giant cat asking her to play, and came away more times than not with a swat on the nose but hardly humbled at all. To this day, Verbal goes up to the various kitties in her life a bit cautiously, fully expecting to get whacked, but unable to resist-she just loves them so much!

Since I brought this broken little thing home kind of unexpectedly, I thought it would be best if I let Michael name her. We had just seen a great movie, "The Usual Suspects," one of Michael's favorites, and the main character, played by Kevin Spacey, actually had two names. "Keyser Soze" just didn't seem like a good name for a little girl puppy, so "Verbal" it was. We kind of thought it would be a joke, too, since how could a puppy whose tongue was ripped off and jaw was broken be very talkative? Ha! The joke was on us! Verbal more than lived up to her name, and very few people who meet her know the source of her name-they just assume it is because of how darned much she likes to talk.

Since she had no trouble eating, she began growing like a weed. It was only two weeks before we realized that pin in her jaw would have to be removed. I took her to work, anesthetized her, and pulled the pin, but during her recovery, Verbal's heart stopped! I went into emergency doctor mode, performing CPR, injecting epinephrine into her heart, and sure enough, that plucky little puppy came back to us. I got the job of reviving her done-then went and puked my guts out. Being mom and doctor at the same time is really hard to cope with, but it was good to know that I could automatically go into emergency mode when needed-and deal with the emotions of the situation later. Verbal actually suffered hypoxia during her cardiac arrest. The lack of oxygen to her brain resulted in her being very wobbly and unsteady when walking for a few days-and scariest of all, she was actually blind for a day! Of course, we didn't know it would only be 24 hours, and it was a horrible time when we didn't know what was going to happen to her. Michael was adamant-we were NOT getting a seeing eye dog for our puppy! Thankfully, she regained her sight the next day, and gradually got more steady on her feet. An anesthesiologist I consulted with thought her blood glucose might have been too low during her procedure, resulting in the hypoxia. While adult or even older puppies can be safely fasted prior to anesthesia, it just isn't safe to do so in these neonates or very young puppies for just this reason. This was just one of so many things Verbal has since taught me about medical issues that I would be able to use for my future patients. I know she came into my life for a reason, making me a better veterinarian, despite what people say about how lucky she has been to have me (a vet) for her owner. She has given me far more in my life than I could ever have given her.

After that anesthesia fiasco, I swore I would make her suck it up and just stand there for her spay. Not really, but I sure was holding my breath during that surgery when she was about 6 months old. I think the anesthesiologist was right about that low blood sugar as a neonate-she has never had anesthetic complications again-and she has had a LOT of surgeries in her life.

Verbal was only about 2 months old when I began noticing how she ran with both of her hind legs kind-of "rabbit-hopping" together. Normal dogs have hind legs that move independently of each other; this rabbit-hopping gait was indicative of pain, discomfort, or at least some limitation of movement in her coxofemoral (hip) joints. We took some radiographs of her hips and found out that she had a terrible case of hip dysplasia. I probably blogged about it before, but where there should be nice deep sockets or cups, Verbal's hips had flat plates. There was no where for the round heads or balls of the femurs to fit. Her right side was much worse than the left, and unfortunately, surgery was in her very near future. I took her x-rays and visited a surgeon I respected and trusted. He told me that the "usual" surgery to repair hips in such a young dog, a TPLO or triple pelvic osteotomy (breaking the hip in three places and plating them together in alignment for the femoral heads to seat better) just wouldn't work because of her particular anatomy. We would have to wait and do at lest one if not two total hip replacements. Since these surgeries can't be done on growing dogs, and since she was already showing signs of pain, we decided to do an FHO or femoral head osteotomy on her right hip. This involved removing the ball and neck of the bone so it would no longer cause bone-to-bone contact and therefore no more pain. Read the blog on 3/24/09 about Quik and his screening for hip dysplasia for more info.

Her hip surgery went well, and so did her spay, thank goodness. She was pretty much pain free-and she went everywhere with me. I was so lucky! I had a small mobile (house and farm call) practice at the time, so she hopped in and out of the truck, waited patiently while I doctored any sick animals, and looked forward to getting on the way again. Well, there are a few things she isn't so "patient" and good about. When she sees cows, for example, she just has to let them know who's boss. She doesn't do this for any other animals, unless a dog is obviously challenging her, jumping up and growling at "her" car-then it is only natural that Verbal gives them a piece of her mind. She also loves to "attack" the scrubbers and brushes when we go through automatic car washes. I really don't think she is afraid or anything-I think it is a big game and she is just having fun. But boy! Those windows get all steamed up and drool-y by the time we are driving out the other side. Nice and clean on the outside-pretty much a disaster on the inside. Oh well, simple joys in life....

I said she went everywhere with me-she really did. When I was doing some relief work, working for other veterinarians at their hospitals or clinics when they were taking vacations or going out of town for some reason, Verbal would always come with me, even when we had to stay in motels. In fact, we became "regulars" at one motel. Verbal and I stayed in the same room on the top (3rd) floor. She would often wake up before I really needed to and wanted to go outside to do her business. I REALLY didn't want to get dressed just to do that and then come back to go to bed again, especially on those cold, rainy, wintery days. I would just open the door, Verbal would run down the three flights of stairs, run to the back of the motel, pee really quickly, and come running right back up to our room. What a good girl!

So, I mentioned that the FHO surgery went well and she had no pain in that hip. This was so evident that she put most of the weight on her hind legs on that leg, and subsequently, one day, playing Frisbee (of course) came down from way too high of a jump and blew out her anterior cruciate ligament (ACL) I've blogged often about ACL injuries-Verbal's was no different-except for the fact that she had surgery on her blown knee 3 times! It now has severe degenerative joint disease, an "end-stage knee" according to the orthopedists, and she will always have pain there. We manage it the best we can using multi-modal analgesia (again, a frequent blog topic) and of course, no more high flying Frisbee games. And now at her age, a couple of tosses and chewing some of the cheap Frisbees to shreds is just fine by her!

Swimming is such good exercise for bodies, human and animal, as it allows working muscle without too much stress on the joints. Now, our hospital is in a community called Lake Stevens-and yes, there is a nice lake here. But do you think we could find a place to swim anywhere on that lake? There are "no dogs allowed" on the public beaches, and I just didn't have any friends who owned property with beach access. I was reprimanded by a "lake cop" one day while walking Verbal on an empty beach; we were standing by some HUMAN'S discarded dirty diaper. I mean, gross. We always carried baggies for "accidents," but there is just no reasoning for some things. I decided to write a short letter to the editor of the Lake Stevens Journal, our local little paper, asking if anyone would be able to offer their yard access to my gimpy yellow dog who needed swimming for physical therapy. The response was just amazing! We have a terrific community of pet lovers, that is for sure! I got over 30 responses offering Verbal a place to come swim any time she'd like. I can't help but wonder how many I would have received if I had asked for a place to swim for myself-a gimpy HUMAN! Another story there....One wonderful lady named Jo actually called me the day BEFORE the paper was released. I was really surprised by this until I learned that she worked part time for the Journal, stuffing inserts in it before delivery the day before release each week. Jo lives alone, her husband had died and her children had moved away. She has a very cute home and a secluded back yard right on the water. Jo offered it up to Verbal and me any time we wanted to come over....She is so sweet, Verbal just adores her, and the little steps going down into the water are perfect for my gimpy old lady. She goes crazy when we are driving up to Jo's house-she can smell the water and it just makes her day! We never stay very long, and I always have to make sure I hose her off really well after the swim. Lots of duck poo and other fun things growing in the water usually give my disaster dog a lovely case of pyoderma (skin infection) if I fail to do that. I never knew a dog could wag her tail while swimming and retrieving. I wish I could take her to the lake every day-such a simple thing makes her so darned happy. It's the least I should do for her.

So, life went on pretty fine for Verbal, normal aging stuff, an occasional lipoma (fatty lump) but nothing too awful. Then came a day when I noticed she was chewing at one of those apparent lipomas on her elbow-she just wouldn't leave it alone. I was constantly telling her to stop it-anyone with an itchy dog knows the lip smacking sound-it can drive you crazy! Then the light goes off in my head-duh! That is what I have clients monitor lumps and bumps for....does the pet "care" it is there? Licking and chewing at a lump is a tell-tale sign that we should remove it, or at least biopsy the thing. Verbal had quite a few lumps at this point, and needed a bit of some dental work, so we went ahead and removed it and sent that elbow lump in to the lab for analysis. Wouldn't you know it? It wasn't just a lipoma, it was cancerous. In fact, it was a type of cancer, hemangiopericytoma, that is very aggressive where it occurs, so much so that the oncologists recommended amputating her leg to control the disease. Ugh.

I already mentioned her terrible hips and the blown apart knee; amputating a front leg would have just been cruel. So, removal of the mass and follow up radiation therapy at the tumor site was the best treatment choice for my Verbal.

I can't remember if I have blogged about radiation therapy in pets yet. If not, I'll go into more detail some other time-it is pretty fascinating! But suffice it to say that Verbal had her treatments-15 of them!-and was cancer-free for 3 years-pretty awesome! Then another tumor popped up at a different site on the side of her chest-totally unrelated to the first one. My girl is just a tumor factory. This one was able to be removed with a very radical surgical procedure, cutting wide and deep margins around it and having those margins evaluated for sneaky little cancer cells. The margins were deemed "clean" by the pathologist, and now, 1 year later, there is still no evidence of regrowth of that tumor, thank goodness. I watch her like a hawk, of course, and every lump or bump she gets is tested with an FNA (fine needle aspirate) while I hold my breath and pray.

Last week we did Verbal's yearly blood panel. I certainly had been noticing her change in eating and drinking habits over the last year-she has been ravenous! She practically takes your fingers off when you give her a treat, and, as gimpy as she is, has been finding ways to get up on the table and counters to scarf up food (especially the cat food) left there. She would drain her water bowl dry on a regular basis, and even raid the toilet for more water. These were behaviors she had never done when she was younger, and I was oblivious, attributing them to being a bad old lady dog, losing her manners or something. Well, the bloodwork showed that she has a very specific reason for these changed behaviors- Verbal has hyperadrenocorticism, or Cushing's Disease. Dang! What more does this sweet thing need to deal with???

I'll blog specifically about Cushing's later on, but basically it is an endocrine (hormonal) disease, caused by too much cortisol in the body. It can occur for various reasons-Verbal's is caused by a tumor on her pituitary gland triggering her adrenal glands to produce too much of this hormone. Cortisol mimics stress in the body, and we all know how much havoc stress can play on our bodies. I guess it is good because we have an answer to why Verbal is behaving the way she is, and can now go about the process of getting her treated for it. As with so many diseases, Cushing's cannot be cured; it will be a condition we have to manage for the rest of her life. Monitoring that treatment is particularly important because over-treatment can be very dangerous; hypoadrenocorticism or LOW amounts of cortisol in the body is Addison's Disease and can result in weakness, collapse, shock or even death.

Whew! That was some blogging I did there, huh? Can you tell Verbal is a "subject" I feel passionate about??? I love that dog, and was just talking the other day with my friend, Valerie, about this very thing. Some times we are lucky enough to have one special dog in our lives, our "heart dog," the love of our life-however you refer to the relationship, if you are fortunate enough to experience it, you just know what I am refering to. This new diagnosis of Cushing's Disease is awful, but we will fight it as we have every other battle in her life. She hasn't stopped wagging her tail, smiling, and just generally goofing around. I saw her upside down, rolling back and forth in the newly cut lawn on Sunday, just reveling in the feel and smells and all. You make what you will of life, and Verbal sure has made hers full and happy, despite all the challenges along the way. Yep, she has taught me so very, very much. I love you, Verbal dog.

Friday, July 17, 2009

Max Can't Catch His Breath

Max is normally a goofy, joyous Labrador, (are there any other kind?) always so happy to visit us for whatever reason-vaccines, ear infections, even getting neutered-you name it. He was always jumping and wiggly and just full of energy. But last week when he came in, things were markedly different for poor Max. He was struggling with something we all take for granted-Max couldn't breathe! Well, not without extreme effort on his part, any ways. He was panting, extending his neck, and just couldn't get comfortable. His owner reported that he couldn't lie down for any period of time and therefore hadn't slept in days. She and her family had actually been gone the week prior and Max had been looked after by a friend during that time. That friend noticed the problem developing towards the end of his stay, but couldn't pinpoint exactly when it started and couldn't tell us what might have triggered it. We were concerned that this could actually become a life-threatening issue, so we worked to get to the bottom of just what was causing the condition known medically as "dyspnea"-literally abnormal breaths.

Max didn't want to leave his owner's side, but we worked gently with him and encouraged him to allow us to work with him. Usually treats would have been welcome, but Max didn't want anything to do with food-it was all he could do just to get air in and out of his body. We had to figure out if this was because of an obstruction in his throat or airway, an infection in his lungs such as pneumonia, or if the dyspnea was secondary to some other condition. Pain and fear often cause our patients to stress so badly as to cause panting when we see them, but Max was having these breathing difficulties at home, too, where presumably he wasn't stressed. Pain was still possible, so we set out to find a possible source of that.

Max's blood work was perfectly normal-surprising since he hadn't eaten in so long. I expected at least some electrolyte abnormalities, but even they were just fine. We did find, though, that whenever we worked with him, Max became cyanotic-his tongue and gums became a distinctly blue or purple color due to the lack of oxygen traveling through those tissues, a very scary finding. We placed a mask over his nose and delivered oxygen to him-he didn't like the smell of that very much, but he evidently liked how it made him feel and he stopped resisting the mask pretty quickly when he realized it meant he could actually breathe with it around.

Next we put Max on the x-ray table and got some radiographs of his chest. It was difficult to get good films because he just couldn't lie in the positions required for very long at all. His blue tongue and distressed/panicked demeanor had us rush the process, but the diagnosis became evident despite the less than ideal positioning. Max had developed a pneumothorax.

Pneumothorax is free air in the space in the chest outside and around the lungs. It may result from trauma to the chest as when ribs become broken when animals are hit by a car, for example. We also see pnemothorax in patients who develop excessive pressure on their lungs, therby overinflating the lungs and rupturing the little alveoli or air sacs of the lungs. Underlying lung disease (asthma, chronic obstructive pulmonary disease, etc.) can also cause pneumothorax, again because the alveoli are damaged and air leaks out of them into the thorax. In some cases, we never do find out the cause of the pneumothorax-that is very frustrating because then we don't know if this will be something that will reoccur (and therefore how we might prevent it.) The problem with pneumothorax is that the air surrounding the lungs doesn’t allow the lungs to inflate normally, so dogs and cats with this condition can have difficulty breathing (the dyspnea we saw in Max), increased respiratory rate, exercise intolerance, chest pain, cyanosis, collapsed lungs, etc. If only a tiny bit of air gets inside the chest cavity, it can be resorbed and the pet can heal without medical help. If there is a lot of air in the chest cavity, however, it must be removed medically. If severe cases are left untreated, or it is progressive as happens with big holes in the chest, the pneumothorax can be fatal.

Max's chest was FULL of air-this was a pretty severe case of pneumothorax, but it did not appear to be progressing rapidly. If it had, he likely wouldn't have still been alive. We searched teh x-rays to find a cause for the free air in his chest cavity. There were no obvious broken bones or other evidence of trauma. We certainly would have hoped his dog-sitters would have told us if he had been hit by a car or had experienced some other massive trauma or had been exposed to any toxins or the like. His blood work hadn't indicated any raging infections as a possible cause, and we didn't see this on the radiographs, either. We were facing an unknown cause of his condition, but at least we knew how to help him. We had to take the air surrounding his lungs out of his chest, and we could do this with a long needle and a great big syringe. Some patients require the palcement of an indwelling valved chest tube, allowing for the continued evacuation of the free air while the patient's body heals from whatever condition caused the air leakage or production in the first place. My biggest concern was that after evacuating Max's chest of all that free air, what would prevent it from coming right back? We just would have to wait and see and hope that it was a one time thing and that his otherwise young and healthy body would be able to heal.

The process of inserting a needle into the chest in order to aspirate and remove the free air is called thoracocentesis. It is important that anytime you insert a needle into the chest cavity that you don't inadvertantly introduce bacteria into it, so we did a surgical prep of Max's skin over his rib cage on both sides of his chest. This involved clipping the hair off and scrubbing the skin with an antimicrobial solution. We inserted a needle into his chest, attached some tubing and a syringe, and pulled some air off his chest-and continued to do this over and over and over for well over an hour. we finally got negative pressure on the syringe after almost 10,000 mls of free air was drawn off the left side of his chest and another 1000 mls was taken off his right side. I suspect the two sides were communicating with each other and the "little" extra taken off the second side was just found in a pocket there, but regardless, it was an impressive volume-over 2 1/2 gallons of air where it shouldn't have been!

It was pretty darned cool to watch Max during his thoracocentesis procedure. Initially, it was very difficult for him to sit still for us; there just wasn't any position where he was comfortable and he became cyanotic very frequently from stuggling/panicking. He required oxygen by the face mask, but we had to just keep forging ahead. As more and more air was removed, Max became visibly more comfortable. At first, we noticed he was simply breathing through his nose; he was no longer open-mouthed breathing or panting. Then he became more and more relaxed to the point he rested his head in his nurse's lap, sighing deeply, and even shutting his eyes a bit. He was exhausted, the poor thing, and relieving the air gave him the freedom to stop struggling and just rest. We all felt so good for him.

We never did find out the cause of Max's pneumothorax, but he was lucky. We sent him home and over night and through the next day, there was no evidence that the pneumothorax was returning. We never did have to place a chest tube, but we did put him on some antibiotics and some antiinflammatory medications. We had Max come in that next day and we listened to his chest, but you could just tell by looking at his face and reading his demeanor that he was back to his happy, rested self-no longer preoccupied with where his next breath was going to come from. His owners were please and very relieved, and it looked like they were able to finally get some sleep, too. Breathing is a good thing.


Friday, June 5, 2009

Kitties Aren't Supposed To Be Yellow

So when Snaps came to see us and we saw the very bright discoloration of her skin, gums, ears-even what should have been the "whites" of her eyes, well, we knew there was something serious going on.

Her owners said Snaps just wasn't herself. She had vomited a few times, but really wasn't eating well and the once very obese cat now just looked moderately overweight-a very dramatic and rapid weight loss for her. Her owners knew something was wrong, but hadn't realized their kitty was practically glowing in the dark.

Jaundice or icterus is the name of this whole body yellowing, resulting from a yellow pigment, bilirubin, normally kept in check by the liver. Diseases of the liver, of course, can result in this icterus, but so can primary diseases of the biliary system itself-the gall bladder or bile ducts. Other less common causes include hemolytic anemias, where red blood cells are destroyed, often by the body's own immune system. Snap's blood tests led us in the direction of her gall bladder-her liver and red blood cells seemed to be just fine.

You have probably heard of bile ducts but may not really be sure what bile is all about. Bile is a greenish material the liver makes, then transports to the gall bladder via small bile ducts. The gall bladder is a small greenish sac about the size of a large cherry in a cat where bile is stored. When the appropriate hormonal signals are present, the gall bladder contracts and squirts bile into the small intestine via one very large duct called the common bile duct.

Bile has several functions. It emulsifies the fat in our diets so that we can absorb it into our bodies. It also serves as a medium to dump toxins that the liver has removed and processed from our bodies. Mixed and bonded in bile salts, these cannot be reabsorbed from the intestine back into the body and are harmlessly excreted in feces.

Diseases of the gall bladder can be infectious, usually bacterial or neoplastic (cancerous) especially in older patients. We also see mechanical problems with the biliary system-sludging or thickening of the contents (bile) or even gall stones blocking passage of the bile through the bile ducts. These can be very painful conditions, and often cause anorexia because every time the patient goes to eat the gall bladder contracts to empty its contents into the small intestine to aid in digestion. If there is a blockage or infection/inflammation, contraction produces pain- the cat will associate eating with pain, so will simply stop eating to avoid that pain.

Now, one would think that weight loss in an obese cat would be a good thing. But cats are difficult creatures, for sure. As obligate carnivores, they require protein daily. If they aren't ingesting it, they will find it somewhere-even utilizing their own liver tissue as a source of that protein. The body will use the liver cells and replace these hepatocytes with adipose or fat cells causing a very serious condition called hepatic lipidosis or "fatty liver disease." Sometimes this is actually the primary disease, but usually there is some reason that the cat stopped eating well.

Since Snaps was essentially starving herself, we anesthetized her and placed a stomach feeding tube. This made it much easier for us and her owners to syringe feed her calculated needed calories each day (rather than trying to do so by mouth and having more of the food end up ON her rather than IN her!) It was also a good way to give her medications-just mixing those pills and capsules with liquids and foods and putting them directly in the tube rather than fighting her for that, too. We prescribed a long course of antibiotics and antimicrobials as well as anti-nausea medication and pain relief drugs. She was also given a whole bunch of fluids under her skin to help start flushing her liver of those built up toxins and pigments. Snaps was also started on a type of medication known as a "cholorectic." Ursodiol or actigal is this medication that makes bile more liquid so that it can flow smoothly without sludging. Flow of bile in the proper direction helps remove not only the toxins the liver is trying to remove in bile but also helps prevent bacteria from swimming upstream towards the liver tissue. We were hoping that her bile ducts were not actually blocked or that Snaps did not have gall stones present as cholorectic drugs would not work for these issues-surgery would be her only option in those cases.

So, Snaps was sent home with a whole lot of nursing care expected of her very devoted owners. They did a fabulous job with her-at one point it even looked like she was less jaundiced and had even gained some weight. But Snaps never did begin eating on her own, and it wasn't long before she began to vomit the food her owners gave in the tube if they tried to give any more than just a minimal amount. It wasn't enough to maintain her weight any longer, and she started getting more yellow by the day. She was licking her lips and acting nauseous if she even saw her owners approach her with food. I strongly suspected a biliary duct blockage or gallstones, but would need an ultrasound exam to be sure.

We referred Snaps' owners to a veterinary internal medicine specialist for that procedure. Unfortunately, their costs were estimated to be quite high, as was to be expected of such a specialized procedure with biopsies and lab reports involved. I had scanned many abdomens but was far from an expert, so offered my services for free just to visualize the gall bladder and liver only and determine the presence or absence of gallstones or big dilated biliray ducts-signs indicating likely blockages. Snaps' owners were very grateful, and it did give me more experience with this procedure.

Well, the ultrasound scan was pretty quick and easy-a homogenic (even throughout) liver-no obvious masses or other defects with a very large gall bladder and hyperechoic (very bright white) structures in the lumen. (center) Snaps has gallstones. No amount of medications will fix these-she has to have surgery to relieve the pain felt every time the organ contracts down on those stones each time she eats (or is tube fed for that matter.) What a horrible situation that must be-to be in pain just because of a basic need and a generally pleasurable function-eating.

We have talked with her owners and will try to come up with a plan for her. While referral to a veterinary surgeon is highly recommended for a cholocystectomy, (gall bladder removal) money of course is a big factor. We might be able to use some funds from our Flake's Angel Fund if the owner can match those funds and attempt to do this surgery ourselves. I have done a few others-it is a very difficult surgery but am hoping to get some tips for better visualization (I have found this to be the key to this surgery) from the veterinary surgeons we work with. They are very helpful that way.

Snaps' owners are saving up their money deciding what they want to do (and what they are able to do.) In the mean time they will continue to try to get food into her, even if it is just small amounts very frequently. Her liver medications aren't as important, but her pain relief meds certainly are.

I'll try to post some pictures of her surgery when/if we get to do it. She is a great kitty and she has very nice owners who are doing a great job with her care. Not all owners would be this devoted, that's for sure.

I felt so bad neglecting my blog this long-it is good to be back!


Monday, May 18, 2009

A Dream Come True

Literally. Ever since I was very young, whenever we would go camping or backpacking and I would see the tell-tale hoof prints of the horses who had traveled along that trail, I imagined and dreamed of one day being the lucky one camping with her horse. And seeing horses galloping on the beach-ah, so majestic and beautiful. I have been a beach lifeguard and a lifelong sun worshiper. I have had opportunities to ride on a beach with rental horses in Mexico and on the central California coast, but never with my own horse. That is, until last weekend. I joined a group on of fellow horse lovers, and due to the generosity of some folks who offered to haul my big horse, took off a couple days (which I NEVER do!) and went to the Oregon coast to go horse camping! We planned for months (having to reserve space for 40 people and horses) and I almost died when my mare came up lame the night before the trip (could only happen to a vet's horse, right?) She got a stone bruise but a little iodine, bute and lots of adrenalin (and a gigantic epsom salt soak in that ocean!) and she was good to go... but not after I said a hundred prayers and cried myself to sleep. Well, the weather was perfect, she never limped a single step, the people were fun, and, well, the pictures say it all. I got to go camping with and ride MY gorgeous horse on the beach-and made it before I turned 50!

I was originally supposed to go with a fellow horsey friend, but she backed out a couple of weeks ago. I still had to go, of course, but was thinking it wouldn't be as much fun not really knowing anyone. When my other friend, Happy, heard I was going alone, she casually invited herself to come along-and boy am I glad she did! She is totally un-horsey, in fact, she has never even rode a horse in her life. But she was my biggest cheerleader-really understanding what this weekend meant to me and being a true friend in every sense of the word. She helped out planning our meals and shopping before hand for gear and supplies. Happy was a great companion for the long road trip, putting up with my choice of "old man rock" music and just gabbing with me during the drive. Once we arrived at the campground, she helped so much setting up the tent and kitchen stuff and all while I got Raquel all situated. And boy did she take some great pictures! I don't have many of her, darn it, since she was the one behind the camera lens, but I will never forget all she did for me and Raquel during our adventure.

Raquel settled into her camp stall just fine. I had been a bit worried that she would power through the chain gate (we have electric fences at home for just that reason) but putting a constant supply of hay in front of her (and keeping her good and tired from all the beach rides) did the trick. Our organizer had recommended to bring one of those pop up canopies to put over the stall so the horses wouldn't have to stand in the direct sun all day (or pouring rain if that was the case.) The horse camp sites were so much better than the regular sites. We had a lot more privacy, not just parked right on top of each other. It was still early in the season so it wasn't crowded at all, but I bet it can get pretty packed in the middle of summer.

A group of us decided to walk our horses out to the beach on foot that first evening-just to give them a "taste" of the salt air, all the sights and sounds and smells and all. I'm glad we did. Raquel was snorting and prancing and dancing-everything was new and exciting. Happy's pictures sure captured the moment. Later on we joined the bigger group for a potluck supper and get-together. Good food and good company. Happy even found that she knew some of the folks from high school if you can believe that! Such a small world. We were pretty tired from all the excitement of a very full day, so turned in soon after dark.

Friday morning we woke up early-well, I don't think Happy and I slept much, actually. We had left the tent flap open a bit and ended up getting pretty wet and cold from all the dew and condensation. It just felt better to get out of the wet sleeping bags and get some hot coffee into us. And I was just itching for that first ride on the beach! I decided to give Raquel some bute (phenylbutazone, a nonsteroidal antiinflammatory drug) for a bit of swelling in the fetlock of the leg with the bruised hoof. That went over well-NOT! She knows just how tall she is, and how short I am! Oh well, she got the meds after a little fight, then off to the beach we went. I went out with a sweet lady named Deb and her older horse, Todd. She wanted to take it slow and easy-just right for our first time. I didn't need a rodeo! We rode over the dunes and out onto the beach and there we were! It was incredible. Raquel continued to dance and prance as she took in all the smells and the sounds of the waves and all. It took awhile, but she eventually splashed through the water when she figured out it wouldn't eat horses. After I felt she had most of the bugs out of her system, we went ahead and took our first run on the beach. What a feeling that was! She never took a lame step, we had the wind in our hair and sun on our faces. Back home Raquel is usually last on trail rides with me legging her on-not on the beach. There she was always wanting to be in the lead, fighting the bit to go, go, go! I think she felt so much more sure of herself there, more balanced where she didn't have to worry about turning every 2 or 3 strides as she does in the arena back home. It filled my heart to see her having so much fun.

My sister Kristine and her partner Kelly had just had their first baby a week before this trip. Since they live in Oregon, I thought I would take the opportunity to go visit since I was so close. I asked my camp neighbors to peek in on Raquel through the day if they could, making sure she had food and water and off we went. Well, it wasn't all that close, what with windy roads, a bad accident on one highway, and Friday afternoon commuter traffic. But I am so glad Happy and I made the trek. Little Aven is just beautiful, and Kristine and Kelly are terrific mommas. The visit was much too short, but I didn't want to leave Raquel alone for too long. I'll get down again soon, I hope.

Happy and I figured out the sleeping/tent situation that night and were much drier and warmer. We both slept better and woke to another glorious day. I rode out again with a bigger group and Happy enjoyed herself sunbathing and just relaxing as she deserved to do. Then we had a great surprise when my husband Michael and Verbal showed up that afternoon! Nobody enjoyed the water and sand as much as my goofy yellow dog.

I got Michael out to the beach and up on Raquel-and he had a great time! He doesn't ride much, but he felt so much more comfortable on her and was soon galloping down the beach like a pro.

You would think that was a full enough day, but no. One of our meetup members, Phil, is very involved with jousting and he brought his authentic suit of armor ( he said it weighs about 100 pounds!) and costume for his horse. Now, isn't a knight in shining armor exactly what dreams are made of?

We had another dry, warm night, time for a quick ride on the beach Sunday morning, then packed up and headed home. It was over much too quickly, but I know Raquel was exhausted even though she would have gone on forever. I'll never forget this trip and all the people who made my dream possible. My terrific staff and our relief doctor took great care of my patients and clients while I was away. Happy was a true friend-what more can I say about that? Michael surprised us by bringing Verbal and joining us for the weekend. And the wonderful meetup group who suggested the trip, made recommendations of what to bring for us newbies at horse camping, and Michelle and John for hauling my big horse all the way down to the Oregon coast. Dreams really do come true.