Monday, September 26, 2011

End of the trend

One of my patients, Maple, is a four year old spayed female. She has a history of chronic urinary tract infections. When they started up again a few months ago, we did multiple urinalysis, urine cultures and extended antibiotic trials. It seemed that no matter what we did, we couldn’t get it resolved. Maple kept licking herself through it all.

Finally, I decided on plan e. The e stands for episioplasty. Maple had an excessive amount of skin folding over her vulva. This created a warm, wet environment resulting in her reoccurring urinary tract infections. This surgery removes the excess skin and fatty tissue from around the vulva.

Basically, the surgery involves making two crescent-shaped incisions around the vulva. As this is a very vascular (many vessels) area, one must take the time to ligate all bleeders. I am now looking into getting an electrocautery unit. Rather than having to ligate the bleeders by suturing them, I could just bloody zap them all! The subcutaneous tissue is sutured back together and finally a simple interrupted pattern is used to close the skin.

After the surgery, Maple's owners had to make sure she wore an Elizabethan collar at all times. She was given NSAIDs to control the pain and they also hot packed the incision to make her feel more comfortable. Apparently, she soon learned those sessions were very soothing.

The top picture is the pre-surgical view. You can’t even see the vulva for all the extra skin. The lower picture was just taken last night. We are about 3 weeks post-op.

Wednesday, September 21, 2011

Oh boy! Here's a new one

Last week, someone brought in a bird that had flown into their window. When it did not get up and fly away, this person picked it up, put it in a carrier and in they came.

When I looked at the bird, it did look a little odd. One of those I’m looking at you but not really seeing you moments. I picked him up to check for broken bones and he tried to bite but he couldn’t succeed. His beak and eye coordination were off by a half inch. As I’m thinking “if I didn’t know better I’d say he was drunk”, Lindsay walked up. She took one look and said “that’s a Cedar waxwing and he is as drunk as a skunk”.

After we sent him home with directions to keep him in the carrier for a couple of hours (to sleep it off), I started to look into these little guys. Cedar waxwings eat a primarily fruit diet and some insects. They eat the fruit whole (so when the berries are overripe and have started to ferment…..). Another cute thing I found out is that during courtship the males will often pass the female a small gift such as a fruit, insect or flower petal. They will pass it back and forth until the female decides to eat it.

Sunday, September 18, 2011

Something so small

A patient was brought in who had a mass on his lower left lip. It had occurred after spending a weekend at the cabin. The swelling had become the size of two large grapes. They had not seen any change in size in a week.

It was fairly easy to see the mass from the outside of the mouth but when the lip was pulled back, you could see the mass and the “weak” spot. He wasn’t thrilled with me doing the examination so we elected to sedate.

When I incised the weak spot, out came some purulent material leaving a pocket. The next step was to flush the area. That’s when it came out. As you can see from the smaller picture it was a grass awn. He was sent home with some antibiotics and within a week, you couldn’t tell he’d had anything there.

The Day I Needed Caller ID

I get some very interesting phone calls. I was reminded of one today when I made myself a peanut butter sandwich (with some great jam thanks to Carol’s mom).

On a daily basis, we see animals who are stressed simply by coming to the hospital. We use treats and toys as a way to make them feel more comfortable. Our goal is to change their emotional response to the situation. No matter what kind of day I’m having, I always have to grin when a dog gets excited when I stand by the cupboard with the treats. Rather than being scared by the procedures they are looking forward to the treat.

Now, back to this phone call. This woman called because her dog was scared of her baby. In my mind I was picturing a toddler running, squealing and falling around the dog. It turned out that the baby was only 3 months old. For a dog to be running away scared from a baby of this age is a very dangerous situation. She told me that she “had done everything” to make the dog like the baby but was very concerned about what would happen when her baby started to move and crawl.

The woman proudly told me that she had tried to make the dog associate the baby with its favorite treat, peanut butter. I was pleased that she was using something which could elicit a positive emotional response until she told me how she went about this. My staff can attest to the fact that my response to the woman telling me that she slathered the baby in peanut butter and had the dog lick it off was not one of my better professional moments! Unfortunately, she had not given me any personal information so I was unable to contact the authorities. Wish I’d had caller ID……..