string-toy CAT-astrophe

Two days ago, a previously frisky 1 year old cat came into the hospital acting very depressed and looking like it was on the brink of death. While taking the history, I discover that the indoor-only cat recently escaped and spent a day or three outside. Upon his return, the owner realized the cat was very ill, as evidenced by the every-hour-for-48-hours vomiting pattern. The owner readily consented to admit the cat to the hospital for further work-up, but it only took a quick look at the radiographs to show us that we were dealing with the dreaded linear foreign body. The owner was able to tell us exactly which toy she believed to be the problem. Surgery was the only option.

Once in the abdomen, a large portion of the toy could be felt in the stomach. The long string-y portion was traceable throughout all loops of bowl with a portion even felt in the colon. A gastrotomy incision was made, which revealed a large (2cm) rubber square with a string attached. An incision was also made in the distal jejunum so that the string could be grasped and cut at that site. With careful milking of the string, and gentle traction on the rubber part, a large part of the toy was removed via the gastrotomy incision. Considering that we were taught in school to "Never Cut The Colon," and because the rest of the toy appeared to be in the colon, it was decided the cat would likely expel the rest of the contents during defecation. The incision sites were then closed up and just as we were closing the abdominal wall, I asked my colleague to attempt to retrieve the string from the rectum. I milked the string and feces further into the colon while she reached through the rectum. Success!! The rest of the toy was out!

Two days later, the cat is acting a little depressed. He is still not eating, but he's not vomiting either. A close eye is being kept on this guy. Stay tuned for recovery updates!

Waiting and Watching

iCat

Ovariohysterectomy Hysteria

If you read my blogger bio or happen to be someone that knows me personally, you know that I am not one to fear surgery. I have a healthy respect for tissue handling and the challenges that potentially may arise from a "routine" surgery, but I don't fear those situations.

Until now.

I've recently been plagued with a number of obese dogs who, as a bonus, have all happened to be in heat. I have been elbow deep in adipose tissue (fat), which makes for a very slimy mess. Think about trying to tie a knot in fishing line after lathering soap onto your hands first. Not easy. Not to mention the vessels I'm trying to ligate (stop the flow) are the size of a water hose. A water hose whose flow I'm trying to stop with fishing line after lathering soap onto my hands first. I even have sore spots on my hands from where the suture and needle holders dig into my skin through my gloves. Just today, during a very bloody surgery, I noticed that my surgery gown was soaked in blood at the spot where I lean on the surgery table. Of course, when I de-gowned, I had a huge blood stain on my shirt. Sheesh.

Shopping for BandAids and Blouses

iCat

MCT update

The histopathology results of the mast cell tumor biopsy brought good news and bad news. Which do you want first?

Good News: The tumor was completely excised! The margins are clean by at least 2cm all the way around. Yay!!

Bad News: The grade of the biospy showed a high grade 2 tumor. Not good in a 2 year old.

I recommended that the family seek the guidance and treatment of our local oncologist. I pray they make an appointment.

Encouraging Oncology

iCat

From Gung-Ho to Takin-it-Slow

I've never been one to make decisions slowly. So it's no wonder that I when I decided I was ready for veterinary medicine to start.... that meant I was ready. Not just partially ready, but full-steam-ahead ready. My hospital has a different mindset, however. I'm advised to "take things slow," and "don't bite off more than you can chew," or "avoid becoming burnt out in 6 months..." That one I hear loud and clear. It wasn't until my boss explained the epiphany he had one day.... This was it. This day-to-day routine that he had going on, would continue to keep going on. So with that advice (and after a consultation with my mother and husband- separately- about whether or not I could slow my roll), I'm going to finally take. things. slow.

maybe.

Taking a Chill Pill

iCat

Check Lump on Side

Yesterday I began to see appointments. It was only Day 2 on the job, but I felt confident enough to begin to see my own appointments and hopefully start building clientèle. It started out easy enough: a handful of vaccine appointments followed by a handful of dermatology appointments. Piece. Of. Cake. Then I pick up a chart that reads "Check Lump on Side." I check the age of the animal.... 2 years old. The lump is just caudal to the last rib and soft but immobile. The client informs me that this lump has been much bigger before, and today appears significantly smaller. She also tells me that another lump was seen along the dorsal midline of his back. This lump is absent.

Ok, so I begin to think of differentials: bug bite, inflammatory process, some kind of blunt tissue injury, hematoma..... and of course (although less likely due to such a young age)... neoplasia. The client consents to a fine needle aspirate, which I immediately perform. I get a surprisingly decent sample, very bloody, and smear it onto a slide and submit it to the pathologist. Without much more thought of the "Lump on Side," I go home for the evening.

First thing today, I asked a veterinarian of 10 years what he believes to be the cause of this "Lump on Side." First question he asks: "Is the dog microchipped?" hmmmmm.... I didn't even think to ask that. He begins to explain to me that the tiny, rice granule-sized microchips can occasionally migrate making a reaction similar to what I was seeing. Seemed like a no-brainer to me. That provided a very logical explanation for this type of lesion in this age of dog. So all I needed now was a cytology reading of "inflammatory cells" to make the conclusion.

WRONG.

Well differentiated mast cell tumor. I was so so so sad. I just sat and read the pathologists description over and over again. The words never changed. I couldn't believe I was going to have to call this woman and tell her that her 2 year old dog has cancer. Luckily, the call went very well. The clients were very receptive to all the information I had and opted to proceed with surgical removal of the mass tomorrow morning.

Crossing My Fingers for Clean Margins

iCat

"Hi, I'm Dr. iCat"

I cannot begin to explain how difficult it has been to remember to introduce myself as "Dr. Lastname." I am meeting so many new doctors, receptionists, technicians, and kennel workers, and I introduced myself to each and everyone as "Hi, I'm Firstname." It was only after one kennel worker asked what he should call me that I realized... I'm no longer just Firstname. I'm Dr. Lastname. Alrighty then.

My first day started out by signing all the PLIT (professional liability insurance) forms. Once that was finished, I was ready to start! As the newbie, I was thrown into the surgery suite to perform enough spays and neuters to sterilize all the animals of a small town in Nebraska. Surprisingly my right thumb and right forefinger did not swell and blister, even though it seemed as if they were actually being sawed off. I finally sat down for lunch at 3pm, which lead me to decide that I must bring lunch/snacks/survival food that can be eaten in increments.

After my 10 hour day, I am still on a high but am exhausted too. Luckily, I didn't feel overwhelmed today. I think I'll catch on quickly. This is going to be a good year.

Learning to Say Dr. iCat

iCat