Monday, November 8, 2010

Moving On

This post won't have much to do with veterinary "stuff," but it does have to do with that incredible connection some of us have been fortunate to share with a very special animal in our lives. It is just personal ramblings-so won't be for every one.

Many of you know I lost my best friend, Verbal, earlier this summer-on Father's Day in fact. I never knew a heart could break like that. I have been so lucky to have good, understanding humans in my life to help me through the loss, but ultimately it has been just a terribly lonely and painful ordeal. Any one who has lost a "heart" dog or cat (or horse or rabbit for that matter) can relate to some of what I went through, and many people have been helpful in relating their experiences. Some told me of dreams or visions they had of their beloved departed pet-and how comforting that was for them. The dream was a way for that pet to "communicate" to their human, to let them know they were doing well, moving on, watching over them, or whatever the message was that they felt their owner needed to receive at the time. Regardless, it was almost always a means of closure, and I was so envious of that!

As time passed, I kept wondering why in the world I wouldn't dream of my dear Verbal dog. We had shared so much in this life, had been so very close, and I began to worry that maybe she WASN'T in a peaceful place, watching over me, maybe she was scared, alone, couldn't "move forward," that I had left things unresolved-you know how a grieving mind can work. I know my husband hurt, too, but he was getting on with life, and he didn't know what to do with me when I was crying my heart out every night. After a month of that, just exhausted from the pain, I did what I thought I "should" do-I got a puppy.

I visited only two puppy "brokers," and that is exactly what they were. The first was a true puppy mill, no matter how nice things might have seemed on the surface, and I couldn't in good conscience support that "business." The second was an actual rescue situation-adult dogs being bred well past "retirement" ages. There were 10 and 12 year old momma dogs with mammary tumors, flea and worm infestations and who knows what else-and I don't think any one could really match up which parents went with which puppies. Selling puppies would help the rescue group get the older dogs spayed and neutered and re-homed. I wished I could have stepped up and taken an older dog, but after just losing one old dog, I knew my heart wasn't in any kind of shape for that. I used my check book to help with what I could, and scooped up a mangy, pot-bellied skinny yellow puppy, was handed a bag of "Atta Boy" dog chow to tide her over ( give me a break,) and headed home.

I texted a picture of her to Michael on the way home. I just got the reply "It's a puppyyyyyyy!!!!" so figured that was an approval of sorts. It really didn't matter much-it was love at first site.

I'll fill you in later on the antics of "Alvy" and her wily ways of working her way into our lives...and hearts over the past few months. Suffice it to say, she has grown from a scrawny 10 pound 9 week-old babe to a pretty robust 6 month-old DOG now.

This past Saturday was a pretty terrific day all around. I soooo wanted to sleep in on that rainy morning, but made myself get up early so I could take Alvy to her training class. We are in a program called Sit Means Sit, and I can't say enough about how well she and her class mates are doing with their training. I should say "our" training-probably 80% or more of dog training is training the humans, and I am definitely in that category. We all meet in "real world" situations-parks and schools-so face all the distractions that are inevitable. It is amazing to see even very young puppies focusing on their humans, intent on figuring out the puzzles and wanting so very much to please. They have such a great time in the classes-lots of work, but lots of breaks to run around and play with classmates or tug on a toy, fetch a frisbee or yes, jump in puddles or whatever. I will certainly write more about this amazing training system-I'm a big fan, not only because of how well Alvy and I are doing, (she was "spotlight client of the month" in November-check out her Bio on their site) but also because so many of my clients and patients have taken part in it and some have begun solving even some major problems like aggression.

After class, Michael and I decided to take Alvy over to a dog park I read about on Whidbey Island. Now, we have plenty of dog parks around here-so why take a ferry ride? Well, the weather has a tendency to be a little better over on the Island, and this dog park just happens to be on a BEACH! Oh boy! Alvy had never been to a beach, and I was very excited to introduce her to all that meant. It was a great choice. The dogs were allowed to be off leash while on the beach itself, so Alvy could run play and body slam with all the other dogs-and of course, find all the dead stinky things to roll in, waves to jump in, and salt water to lap up (before she figured out that wasn't such a great idea!) We must have played for 2 hours-I thought I'd have to carry her back to the car, but she made it just in time to collapse on the pile of towels I actually remembered to bring. She was so darned happy! It did my heart good to give her this gift. I know we have other beaches pretty close, and this one really wasn't far at all-we will be doing the beach thing a LOT!

You can imagine we all slept very well that night. I had actually been pretty sick for several months and was finally starting to breathe better and sleep through an entire night without waking up in fits of coughing. And guess what happened that night? I dreamed about my dear sweet Verbal dog! It wasn't anything earth shattering or unusual-she didn't talk to me or anything like that. She was just comfortably walking by my side as she always did-and now I knew she always would-my old friend was there by my side, or rather, we were together, by each others sides-forever.

I know that after 5 months of wishing and hoping for a "sign" from her, my dear Verbal came to see me after we gave Alvy a perfect day-and she told me that was as it should be. Life goes on. The young whipper-snapper deserves all the love we have to give her (and all the stinky dead things to roll in!) Verbal was telling me that Alvy was lucky to have come in to our family-she would always know love and care (and fun!) but we are lucky to have her in our lives, too. Verbal would have hated having the youngster around her-it is why we never did have other dogs while we had Verbal. Young puppies were big ol' pains, disrespectful of older dogs who might be hurting like Verbal did. Despite this, Verbal was acknowledging that her humans' happiness was the most important thing to her-and if this obnoxious puppy could give us that happiness, that was as it should be. And by the way, she (Verbal) wasn't going anywhere. She would be right by my side as that puppy frolicked ahead. Moving on certainly doesn't mean replacing or forgetting.

Oh my. I have never been more relieved (or more happy) to have dreamed such a simple thing. It only took 5 months of wishing and hoping and praying...

A few hours later I was in church...and realized it was All Saints Day. We lit candles in memory of family or friends who died this past year. You can bet I lit a candle for Verbal. She was family. She was my friend. There was no one who better fit the qualifications. A friend sent me the link to this very sweet song/poem about dogs and God-check it out if you have the time. God and Dog

I have had quite a few friends and clients ask me when I might start to blog again. I don't know if I can keep up the momentum, but telling this story of Verbal's dream visit seemed worthy of an entry, maybe the start of something regular. But regardless, it is a pretty good story, isn't it?


Friday, February 5, 2010

That's a Mouth Full!

This week one of my tiniest, sweetest little patients was diagnosed with a problem that is quite a mouth full to pronounce: crycopharyngeal achalasia. Whew! It made me think back-WAY back-to my first medical terminology class. I took it as an undergraduate student at Cal Poly in San Luis Obispo. I liked it because it wasn't a course where you had to memorize lists and lists of those mile-long, foreign words. Instead, we were taught how to break down those words in their prefixes, suffixes, roots and parts-dissecting them if you will- and this way found we actually knew the meaning of most of those daunting words, even if we had never heard each one before.

We started with the basic terms we learned in our anatomy classes, words describing parts of the body, organs, etc. Derm refers to the skin, osteo to bone, cerebral to the brain, cephal is the head, coreo is the pupil of the eye, and cardio the heart. Cysto refers to a bladder, renal or nephro to the kidneys and hepatic to the liver. Chol refers to bile or the gall bladder. Ovo refers to the ovaries while orch refers to the testes. I wasn't amused when we learned that the root for uterus was "hystero" because females were considered "hysterical" by their doctors. Wonderful. Metra can also refer to the uterus.

We then learned the prefixes that describe these organs or conditions. "A-" can simply mean without or not. "Neo-" is new or recent. "Bi-" means two or double. "Iso-" means equal or alike. "Endo-" means within. "Pyo-" refers to purulence or pus.

Suffixes might further describe or quantify conditions or situations. "-algia" refers to pain or a painful situation. "-itis" refers to inflammation. "-osis" simply refers to "the disease or condition of." "-lith" refers to a calculus or stone. "-otomy" means to surgically cut into while "-ectomy" means to surgically remove and "-ostomy" means to crate a permanent hole in. "-oma" usually refers to a benign tumor while "sarcoma" refers to their malignant counterparts.

So, let's try out your new skills in medical terminology. Break down the big words into their smaller, more familiar parts and see what you come up with. You will be surprised how easy (and even how fun) it can be!

1) Dermatitis
2) Nephrectomy
3) Pyometra
4) Endocardiosis
5) Cholecystolith
6) Ovariohysterectomy
7) Osteosarcoma
8) Acholiosis
9) Tracheostomy
10) Isocoria

Ok, here are the answers-I'm sure you got all of them right!

1) Derm-skin + itis-inflammation = inflammation of the skin
2) Nephro-kidney + ectomy- surgically remove = to surgically remove the kidney
3) Pyo -pus + metra- uterus = pus in the uterus or a uterine infection
4) Endo-within + card-heart + osis-condition or pathology of = disease inside the heart, actually refers to a disease of the heart valves (which are inside the heart-see how this works?)
5) Chol-bile/gall + cysto-bladder + lith-stone = gall bladder stones
6) Ovario-ovaries + hyster-uterus + ectomy = removal of the uterus and ovaries-in dogs or cats, we call this a spay surgery.
7) Osteo-bone + sarcoma-malignant tumor = bone cancer
8) This one looks hard, but just break it down...a-with out + chol-bile + osis-condition of = the condition of not being able to produce bile.
9) Trache-refers to the trachea + ostomy-to create a permanent hole in = creation of an opening into the trachea.
10) Iso-the same + coria-refering to the pupils of the eye = having pupils that are the same size.

Look at that! I knew you could do it. See? Doctors really aren't all that smart. Using big words just makes them sound that way, and now you know the secret behind doing that, too. And it doesn't even give you cephalgia (a headache) to use those big words, too.


Tuesday, January 26, 2010

No Puppies for Heike

Heiki wasn't feeling quite herself. Normally vivacious, full of life and energy, the first day we saw this wonderful Coton de Tulear, she was a little down. She was fortunate to be owned by a very observant lady who noticed early on when something wasn't quite right and brought her in for an exam. She noticed that her appetite was off the past two days or so, and most significantly, Heike had some clear, shiny discharge from her vulva which she kept trying to lick clean. Her temperature was a bit elevated, too. Heiki's owner also happened to be her breeder-and was very knowledgeable that these symptoms could be signs of trouble with the reproductive tract. She told me that Heike had been bred 3 weeks earlier.

By far, most breedings of dogs happen with no problems at all. But the process isn't exactly sterile, and bacteria can get introduced into the reproductive tract of the female dog during mating. They will migrate up through the cervix, which is relaxed during estrus instead of being closed tightly as it is during the rest of a dog's cycle. The bacteria then start to reproduce in the uterus, creating an infection here we call a pyometra-literally "pus in the uterus."

We can see two types of "pyos," open and closed. These descriptions refer to the cervix, and tell us if the infection is trapped or contained in the uterus creating a life-threatening "balloon" of infected material or if the bacteria and pus is able to drain or leak out of the uterus through the cervix. Both are incredibly serious problems for any dog, much less a breeding female.

Now, the discharge coming from Heike's reproductive tract at this point didn't look like pus-it was clear with no blood or other cells in it at this point. We decided to do an ultrasound exam of her uterus and see just what was going on in there. We shaved some of her glorious long white hair from her abdomen and very quickly confirmed that Heike was, indeed, pregnant. This certainly made our treatment decision more difficult-if it was at all safe to do so, we would like to be able to continue the pregnancy. Since we suspected the discharge could be normal or could be early signs of the pyometra infection we were concerned about, we talked at length with Heike's owner. Another possibility was that the pregnancy was trying to resorb or abort for some reason. We trusted that Heike had the type of owner who could carefully monitor her condition, give medication as directed and watch for the changes we discussed. If Heike stopped eating or started vomiting we wanted her right back in. If her temperature increased, or if the vulvar discharge turned milky or creamy we needed to recheck her. Many dogs with pyometra will start to drink water excessively, so we wanted to watch for this, too. Since we knew she was pregnant, monitoring for a distended abdomen wasn't going to be very helpful. But if she became painful in her belly, that would be a bad sign. We gave Heike a prescription of an antibiotic we felt would be effective for an infection in the uterus but would also be safe for developing puppies, gave her some fluids under the skin to help her hydration and slight fever, and sent her home.

Heike's owner was diligent in medicating her and giving her fluids, orally and subcutaneously. She monitored her vital signs as we asked, and Heike did pretty well for about a week. About that time her temperature actually decreased to below normal and she stopped having any vulvar discharge. We had her come in to reevaluate, and did some blood work and another ultrasound exam. The blood work showed a significant elevation of her white blood cells, a tell-tale sign of infection in the body despite the week-long antibiotic treatment. The ultrasound exam showed that the pregnancy was not progressing as expected. In fact, while we could see the individual vesicles of amniotic fluids, no evidence of feti were found in those vesicles. The uterus itself was very large and fluid filled. With no vulvar discharge seen now, we diagnosed a closed pyometra.

As mentioned before, a closed pyometra is a life-threatening condition. As the uterus fills with pus, the wall of the organ becomes stretched thin and attacked from within by the bacteria, weakening the tissues and making rupture of the organ very possible. The only treatment is an emergency removal of the uterus, hopefully before any rupture or leakage of any amount occurs. We rearranged our schedule and got her right into surgery. It was a good thing we didn't wait.

Normally a thin band of tissue, sometimes even difficult to find among all the intestines and other abdominal contents, Heike's uterus was huge, bulging up right under the incision I made in her abdominal wall. I exteriorized it carefully, revealing the "balloons" we saw on the ultrasound exam.
While thinning in some areas and obviously very diseased tissue, there were thankfully no obvious tears, ruptures or leaking areas. Gentle handling was essential to keep that from happening. I wanted to remove the entire pus-filled uterus, along with both ovaries and the supporting tissues without spilling the contents into the surgical site. Unlike in a human female where the uterus has a simple body, (just fine for a single fetus) the uterus in a dog consists of two "horns," much better suited to accommodate the numerous developing puppies or litter. You can see Heike's diseased uterus kind of looked like big sausages-very abnormal.

We were able to remove both of Heike's uterine horns and ovaries without obvious pus contamination of the abdomen, but we flushed out her abdomen with warmed, sterile saline as a precaution, explored the rest of her abdominal organs briefly and found no other problems, and closed her incision. After we removed the diseased organ from her body, we opened it up and found that, sure enough, it was filled with a huge volume of a nasty, strawberry milkshake colored liquid that anyone could tell wasn't normal. The entire surgery was less than 30 minutes, but without it, this sweet little dog would certainly have died from that infection.

It is tempting to treat these dogs like those we have spayed-just a "routine" procedure, especially when they do as well as Heike did. But that would be a mistake, and could have resulted in a decline in her condition later. There was nothing routine about needing to rush to surgery right away. Heike had no time for adequate preparation before surgery, such as fasting, and she was only started on her IV fluids minutes before I made the incision into her abdomen. That uterus was hardly normal, and her blood work showed an obvious affect on her entire body from sepsis or pronounced infection. Her lower than normal body temperature was a sign that her body could no longer handle things on its own and might be facing impending shock. Heike was placed on a different, more powerful antibiotic, one we couldn't use earlier when we had a potential pregnancy to consider. She had aggressive IV fluid therapy and her nurses got her body temperature back up to normal-and kept it there. Her surgical pain was managed well with narcotics before and after surgery, as well as a non-steroidal anti-inflammatory medication. She was also sent home with an appetite stimulant, as getting her to eat right away would be very important to her healing process.

Heike was fortunate that her owner knew the signs of pyometra and how serious it could be. Even if an owner didn't know about this disease specifically, just knowing the "normals" for your pet, his or her normal habits, appetite, activity level, etc. really goes a long way to helping know when something just isn't right. It is the veterinary team's job to then try and figure out why that is-working as a team, we got Heike all fixed up, sent her home to her owner and when we later rechecked her, found that she was the happy, healthy dog she had always been.

But even happy and healthy isn't enough if you are a female dog living with a breeder-and you don't happen to have a uterus! Heike needed to find a new home, and that she did. She actually got to make a plane trip across the country, and now lives with another sweet "cotton" dog, MC. Heike is now known as Olivia-and she couldn't be happier! Her new owner opened her home and heart to this sweet little girl. We are glad that everything has worked out so well for everyone. Good luck, sweet Olivia!