I'm becoming a blogger slacker. *sigh*
But I was at work late last night. Ate dinner at 10pm and went to bed. No bloggie.
Last night I was all set to leave work around 8 - but got a phone call from my brother that lasted 45 minutes. Was a GREAT conversation - perhaps the best we've had in a year (so it was totally worth it.) I finished my chart goals for the day by 9pm, went downstairs to leave, and found....
This dog. Dixie. With her IV catheter merrily chewed out therefore not giving her the fluids she needed - wagging her tail.
Little sneakster!
I would not have left any patient in this state, but ESPECIALLY not Dixie. I love her. And she and I have been down quite a road together.
I've taken care of her for years - routine stuff, mostly. Nothing drastic. And then last October, things changed.
Dixie's owners are wonderful people. They don't have kids and they really treat their dogs like their children. Loving. Attentive. Rational. (It is the last quality I love most about them!) :) They went on vacation and left Dixie and their other dogs at the nicest boarding facility in town - another vet clinic with a really deluxe set up.
They were home for a week when Dixie began vomiting. They took her to the local emergency clinic and she was diagnosed with pancreatitis. Her bloodwork was typical for it, she had all the clinical signs, and she was positive on the new fancy snap ELISA pancreatitis test (something our clinic does not utilize.) She walked like a duck, quacked like a duck, so we treated her like a duck. And she responded!
After a solid 24 hours of no vomiting, we fed her. She did not vomit! Yay! So I happily sent her home.... where she started vomiting. :(
She came back into the clinic and I repeated my physical exam - she was no longer painful when I palpated her belly and she was perky - wagging her tail and jumping up on me and giving me kisses. We fed her and she ate and did not vomit. I sent her home again. Guess what? She started vomiting again! Grrrr!
The next day she was fine. No vomiting. Eating happily and everything. The day after that she was back to our office - and this time things had changed. She was sick. Really sick. Her abdomen was extremely painful. She vomited up what looked like poop. So I took some x-rays: things were bad.
I can't recall the exact details, but I knew that something was wrong with her stomach. Her presentation was not typical for a foreign body (something stuck in the GI tract that she might have swallowed) and she was not typical for pancreatitis. She was not typical for anything!
I saw something that made me very anxious about a tumor. Dixie is not a young dog - so cancer was a real possibility. I had a very frank discussion with the owners and after we decided on exploratory surgery to find out just what was going in her belly, they agreed to be in the building as I opened her up. If I found cancer, I would let them come back and say good-bye and we would not wake her up. We would euthanize her while she was under general anesthesia. If I found a foreign body, we would all rejoice and I would remove it and Dixie would live on.
They took Dixie for a walk and sat with her for a long time before we took her back for surgery. She felt so bad. She was so sick. She is a Mountain Fiest and is very tough - but she was failing. Her owners knew this might the last time they saw her, so they were just trying to soak her up.
We all held our breath as I opened her abdomen. I found her stomach and as I put my hand on it I exclaimed "there's something IN there!!!!!" YAY!!!!! NOT CANCER!!!!
And then I kept looking.... and my heart sank. I said to my messenger to the owners "wait. there is bad news. there are two holes in the intestines - she has been leaking intestinal contents into her abdomen. this is really bad. tell them that i'll try to fix her - but she may not make it."
Before I started into surgery, I had placed a phone call to a local surgeon for advice about something that I was worried about finding. I honestly don't remember what that was, now. Regardless, his staff told me that he was off for the day but they would call him and relay my question. He called our office and gave us his cell phone number if we needed him. Dr. Barton called him because I was not sure what to do. I wasn't sure whether it was best to try to close the two small holes or just to remove that portion of the intestine and suture the two ends back together. He gave me step by step instructions and I closed up the two small holes. I removed the entire foreign body - which was a wad of strings all balled up - and spent the next hour closing up all of her little holes and making sure they were not leaking. At that point, I had had Dixie on the table for 2 hours. For 2 hours her owners had been waiting. I flushed her abdomen with warm saline over and over and over again trying to minimize her chance of developing a life-threatening infection in her entire abdominal cavity. We were taught in school that 'the solution to pollution is dilution.' So I flushed and flushed.
My heart was lighter. She was all patched up, I had done my absolute best work (with the help of my staff and the surgeon) and Dixie was going to wake up and feel much better.
Just before I started closing her abdominal muscles, I picked up her incision and looked forward towards her chest. And I saw her liver.
Her liver was completely, totally, undeniably covered in tumors. There was not one inch of normal liver tissue visible. I cursed and stomped my foot. "NO!!!"
I looked at my technician and said "I don't care. I've fixed her. I've spent the past 2 hours fixing her. I'm closing her up and waking her up. I was meant to see this last. If I had seen it first, I would have euthanized her right there and then. But I did not see it until NOW. That's on purpose. So, she is waking up."
I closed her up as quickly as I could. While she was still recovering from anesthesia, I went to talk to the owners.
I walked into the exam room and said to them: "I have good news. I have bad news. And I have really bad news." And then I broke. Tears streaming down my face, I told them of what I had seen. But I told them that I firmly believed that God had not intended me to see that until right when I did. Dixie had time left. She had good life left. It was not time for her to leave us.
Just then, someone interrupted me to let me know that they needed me right THEN. The tone was filled with anxiety.
Dixie was having a massive seizure. I quickly gave her some IV valium which ended the seizure and I checked her blood sugar - it was normal. (Low blood sugar from liver issues, major infection, not eating for days could all be at play and could cause seizures.) I ran upstairs to find a very important phone # - the personal cell phone of Dr. Ralph Harvey.
I need to digress in my story for just a moment to tell you how fortunate I am to have had the professors I had in vet school. I have called on many of them numerous times since graduating and they have always, always been a wonderful, caring, encouraging resource of wisdom and knowledge. Dr. Harvey is counted on that list. I have called him when disasters have struck - when my patients have died under anesthesia and I couldn't figure out why. He is a calm, reassuring, helpful teacher. And he is a great anesthesiologist that I am proud to have been taught by.
He answered immediately and I asked him if he was free. He was. I quickly went over the situation, and he stopped me: "is she currently on oxygen?" I answered "no, she's still intubated, but not on O2"
He firmly stated "put me on hold, go tell you technician to put her on oxygen NOW, I'll wait."
I ran downstairs and did just that. I picked the phone back up and continued the conversation. We went over drug doses and determined that all was done correctly. Her failing liver function or her infection causing clots to the brain could be to blame.
He told me that he thought she'd be ok, but time would tell.
I went back into the exam room to tell the owners what just happened. Then we waited.
After an hour, Dixie finally regained consciousness. We removed her endotracheal tube. She didn't have any more seizures. She seemed ok. Dr. Harvey called me back to check on her - and the technician who took the call relayed that she was doing well. I was pretty amazed that he called to check on her - he's a busy guy. This was not an animal that I was going to refer to him. He had no connection to her at all but through me. It still warms my heart that he called.
The next 48 hours were super critical and important. I sent her to the overnight emergency clinic for post-op pain meds, antibiotics and fluid support.
And then I left for a 10 day vacation.
I left her in great hands with Dr. Barton, Dr. Bowman and Dr. Nice - but it was SO hard to leave. It was SO emotional.
I got on a cruise ship and had no internet contact for days. As soon as we were back stateside, I checked my email. Dixie was doing great! I was so relieved and so happy!
I have seen her every 3 months to check her liver function and she has been holding her own. Gaining weight, happy, active - normal Dixie. She just started getting sickly this past week and her liver is angry. Dr. Nice saw her yesterday and put her on IV fluids to try to get her feeling better. It worked. The little gal chewed out her catheter after laying around all day!
But with the help of a future veterinarian named Bethany who came back to the clinic at 9:30 at night after starting her morning there at 7am, we got her going again and put an e-collar (the cone of shame!) on her to thwart her line chewing. Today she went home feeling much better. :)
I don't actually think she has cancer of her liver. I think she likely has cirrhosis (and her owners promise me she is not a drinker!) and her liver is wearing out.
Her time is short. We all know that. But so far, it's been 9 months longer than it would have been - thank goodness I didn't peek forward first. :)
Her owners were so grateful that they not only sent me and my staff a thank you card and gift, but they sent one to the surgeon who took my call on his day off and also to Dr. Harvey.
I saw Dr. Harvey in December and was able to thank him to his face for his help. He told me of the nice card he got from Dixie's owners and how he had read it to the entire department.
I'm so glad to be in this profession and to work with such great people.
And little dogs like Dixie and owners like hers make it all worth it. :)
Thanks for fighting girl, let's make it a year, ok? Or maybe two.
