3/26/2009

Why Veterinary Medicine is Uber Cool — Part 3

MargaretMargaret
Filed under: @ 10:07 am

This seems to be a recurring theme. Maybe, if I can do it without getting too gross, I’ll continue to post cool little bits like this now and then. I’ll attempt to not break down into ranting either. Andrew knows all too well how often my days at work degenerate into ranting. I’ll try not to rant.

ANYway…
I mentioned during my last post that I’d get back to how I knew that it was spring. I’m a soothsayer.
Well, not really. But I do practice visceral diviniation. See, cats are long day breeders. This means that female cats start going into heat when the day period starts to lengthen. If a female cat is in heat, you can most certainly tell when you spay her. Every she-cat that I’ve spayed since the first part of February has been in heat, therefore, it’s spring. The cats’ uteruses tell me so. ūüėÄ

Back to why veterinary medicine is uber cool.
Two Wednesdays ago I was looking over my schedule for the day. I do surgery on Tuesday and Wednesday mornings from 0700 until I finish in the early afternoon. My first appointment of the day isn’t until 2p.m.
That Wednesday I saw that my 330 appointment was scheduled as: “Alex, 10 year old Siamese, dragging his back end”.
That got my alarm bells ringing. Cats almost never have the slipped intervertebral disc problems that affect some dogs and make them drag their hind ends. It’s rare for a cat, especially a 10 year old cat, to break a leg unless he does something like fall off a roof. Cats just generally do not drag their hind ends unless there’s something catastrophic happening. The most common catastrophe that will cause a cat to drag his hind end is what’s called a saddle thrombus.

*pause for medical stuff*
The aorta leaves the heart and travels along the midline of the body supplying major arteries to the thoracic and abdominal organs. Just below the pubic bone the aorta terminates, forking into the two femoral arteries which supply the major blood vessels for the back legs.
I don’t know whether or not this happens in people, it almost never happens in dogs. Under the right conditions, usually massive underlying heart disease (for instance, the first cat in which I saw a saddle thrombus had seven chambers to his heart), a clot will form that travels to the terminal aorta and blocks the blood flow to the femoral arteries. Bad news. Way bad news. Uber bad news.
Generally cats that present because of a saddle thrombus are screaming, literally, painful. Aortic thromboemboli (ATE) cats can usually be diagnosed when they are carried into the hospital.

The appointment book didn’t say anything about Alex crying and dragging his hind end, but still….
I asked the receptionist if Alex’s people WANTED the 330 appointment or if they had taken it just because it was the first appointment available. It was the latter, so I had the receptionist call them back and bring the cat in so they could drop him off and I could look at him while I was in between surgical procedures.
Reception called them, the mister brought the cat in about half an hour later.

I wasn’t in the middle of something when Alex came through the door so I had the reception people tell Alex’s dad to wait while I took a preliminary look at him.

Alex most certainly was dragging his left rear leg. While the nail beds of both rear legs were still pink (with a saddle thrombus the nail beds will be blue), the pads of both rear feet were cooler than those of the front feet which could possibly indicate poor circulation in the femoral arteries. Alex didn’t seem to have any notable orthopedic pain, in fact he didn’t seem to be painful at all, he was just lying on his towel purring and making happy feet with his front feet.
Odd.

Then I put my stethoscope in my ears.

*a second pause for medical stuff*
Normal resting heart rate on a cat is in the 120-150 beats/minute range. A cat that is stressed out by having been shoved in a traveling crate, by having been shoved into the car, and by having a stranger poke and prod at them will have a heart rate in the 180-250 beats/minute range. I’m never even really concerned when they hit 280, although that does generally indicate a pretty freaked out cat.

Alex’s heart rate was in the 420-450 range. ūüėĮ
According to my assistant, my eyes went really wide, I checked the clock, checked my stethoscope and then, having put the stethoscope back on the cat again, my eyes went even wider.
My assistant is fairly used to me by now. Unlike most of the other staff at this hospital (including, to a certain extent, the other two doctors) I’m used enough to crashing emergencies not to get too ruffled by much. When my eyes started popping and I asked her, with the stethoscope still in my ears, to get the other on duty doctor, she BOLTED.
My boss came, I stepped back, and gestured for her to have a listen. She put her stethoscope in her ears and put the bell on Alex’s chest. Her eyes went wide, she checked the clock she checked her stethoscope, and then went back to listening to the cat.

This is what is known in medical slang as a “don’t die on my shift” moment. Depending on one’s particular brand of medicine it can also be “don’t die on my floor/don’t die in my bus/don’t die in my hospital”, but the underlying sentiment is the same.
I am rarely certain about anything in medicine, I’m too cautious to be so, but I can be certain when I say that that cat would have died within the next 12 hours if something hadn’t been done.
The only thing I could focus on at that moment was getting that cat out of the building and somewhere that he could be helped before he died. The subtlety of medicine, however, is to be able to convey that urgency to a lay person, without getting them so freaked out over how freaked out you are that they are incapable of making any rational decisions.

When I went to talk to Alex’s dad I was cool, I was collected, and I was rational. I was not, in fact, subtle.
I told him the cat was going to die, I told him there wasn’t anything useful that I could do to stop it. I told him the cat had a chance at living if he’d get the hell out of my lobby and take Alex to the specialty center where the critical care doctors could put him on medications that would slow his heart down before he blew another clot to something more vital than his left femoral artery.
To his credit, Alex’s dad didn’t freak out at my freaking out.
More to his credit, he actually was willing to do something useful for his cat instead of opting to try the band aid approach which my hospital was equipped to offer. Which would have been rather like trying to repair a decapitation with a butterfly bandage.
I have to stop here and note that I mean no disrespect to my hospital by describing our capabilities to treat such crashing emergencies. The honest truth is that we are simply not equipped, not staffed, and not scheduled, to deal with critical patients. Our mission is not to be an ICU, our mission is to be more like your GP’s office. We’re able to deal with the day to day medical stuff that our patients require, and anything more complicated than that generally gets referred somewhere where they are equipped for the complicated stuff.

I loaded Alex up with some *really good* pain medication, bundled him back into his carrier and told his dad to get OUT!
To my knowledge Mr. Alex didn’t break any laws in getting from Renton to Kirkland with his scary ass ticking time bomb cat in his car. I did, however, send them out the door at 0830, and got notification from the specialty center at 0930 that the cat had been admitted. For a weekday morning from Renton to Kirkland on SR 405, that’s an admirably short period of time.

Alex saw the cardiologist that day and had an ultrasound exam of his heart. Alex also had a full blood chemistry workup. Cardiology found that the walls of Alex’s heart had thickened to the point that his heart chambers were too small (a condition called hypertrophic cardiomyopathy which I won’t define any further). Blood chemistries showed that Alex’s total serum thryoid hormone levels were at 17.6. Normal for a cat is 1.5-4.5. The combination of the underlying heart disease and the cardiovascular effects of too much thyroid hormone (hypertension and elevated heart rate) had caused an electrical short in Alex’s heart.

Last Monday I got the final records from the specialty center for Alex’s stay. Alex had been hospitalized for two days during which time his heart rate and rhythm were converted to something more approaching normal. Alex was discharged with a pile of cardiovascular and anti-thyroid medications.
I saw Alex last Wednesday for a recheck.
The quiet, purring cat whose heart rate I’d not been able to count had turned into a bright, active, vocal cat with a heart rate of just under 200 beats per minute. The rhythm ain’t normal yet, but we haven’t gotten Alex’s thyroid levels back inside the normal range either.

Veterinary medicine is so cool!

3/17/2009

Linus Had It Right

MargaretMargaret
Filed under: @ 12:44 pm

Linus Van Pelt, you know, the kid with the blanket?

When I was young I was almost inseparable from my security blanket. By the time I was old enough to remember the particulars about it, it was already a ragged fragment of cotton waffle weave thermal fabric with the silky binding around the periphery loved to shreds. By the time I was old enough to be willing to give it up it had gotten so fragile that my mother had had to make me a flannel pillowcase to keep it in so I wouldn’t lose bits. I was always a very formal child though. Like Linus I never referred to my blanket as a banky, a binky, or even a blankey. My blanket was always “my blanket”.

Fast forward a lot of years.

In November of 2007, when Andrew had his second back surgery, I took a knitting project with me that I had started -heck- even a decade previously. I’ve pretty much always known how to knit. Watching my mother knit everything from afghans to sweaters to a ham sandwich (really) as I was growing up, it didn’t take much figuring for me to pick up a pair of needles and start klicketing away. I’d never really gotten into knitting in any serious way though. But when I was facing several hours in a hospital waiting room, wound so tightly that I’d have exploded like a watch spring if I’d not had something on which to concentrate…. Well, I figured that knitting would at least keep my hands busy enough that I’d not chew my fingernails down to the cuticles while I was waiting. Besides, I had it in mind that Scrum could use a new blanket. Scrum always loved the texture of knitted things.

And I re-discovered a lost pleasure. Knitting takes enough concentration that one can watch TV (god help you in a hospital waiting room, though!), have a conversation (I didn’t) or listen to a book on disc. My mother can knit and read at the same time, but I’m not that coordinated. So I sat for several hours and, using the tail ends of I don’t know how many skeins of yarn that had been sitting around my study for years, knit probably eight inches of a remarkably ugly blanket which, when finished a few days later, Scrum loved with a passion.

We went to Hawaii for Christmas that year. Before we left I approached my mother to see whether or not she had any ideas for square or rectangular knitting projects with which to distract myself on the airplane. Five hours (one way) crammed into a metal cigar tube inhaling each other’s exhale is usually enough to make me more than a little jittery and I was hoping to have something mindless, but involved enough to keep me from running amok in the middle of the Pacific. I’m not up to knitting complex things. I can knit, with some accuracy, square and rectangular things. Beyond that I tend to be a little spotty.
Mother, bless her, had the perfect solution. The Bellevue Unitarian Church sponsors a low income housing unit, providing furniture, kitchen equipment, dishes, linens, etc. Every time a new family moves into the apartment, the knitting ladies of the church put together an afghan which the family takes with them when they move out. Mom needed knitted quilt blocks, 36 of them, 6 by 9 inches. She even had a box full of the ends of skeins of yarn that she was planning on using for the project. I’m GOOD at knitting rectangular things.
So I spent two weeks in Hawaii, the weather was warm enough but it was rainy and blowing in turns, and two airplane flights knitting myself silly. All of Mom’s acrylic yarn ends as well as an additional 6 skeins were transformed into quilt squares.

Scrum died soon after we got home from Hawaii in January. I’ve written elsewhere about my feelings then. One of the more notable holes that Scrum’s death left in my life was that I no longer had something to keep my hands busy when I sat watching television in the evening. Scrum was a passionate lap sitter and I was used to having a cat tummy to massage any time I sat on the sofa. After a few days of sitting and chewing my fingernails I got out my knitting needles again. All my knitting in Hawaii had gotten Joan inspired to work on a project for a friend of hers. Knitting scarves for a charity in Tibet that provides scarves, hats, mittens, etc. for Buddhist monks.
Minus my cat to tweedle and my mother having no further need for quilt blocks (at least for the time being), I knitted a scarf for Buddhist monks. Scarves are rectangular! I posted the scarf off to Joan and without any further ideas of my own, called my mother again. What can I knit that’s rectangular or square?

Enter The Linus Project.
The Linus Project donates blankets to children’s hospitals, homeless and women’s shelters, basically anywhere that there are likely to be distressed children. A child picks a blanket and has a soft, warm, hand made snuggly for their very own to give them comfort, shelter, and security.
As a grown up Linus, I couldn’t think of a better outlet (nor a better use) for my ingrained need to fidget so I started in.
linus11
linus2
These are two of the four that I’ve finished for The Linus Project. The fourth isn’t bound yet, but it’s done besides that. I’ve discovered that knitting with kittens in the house is quite a challenge so I’m not sure I’ll be continuing to knit blankets……. but I’ve recently picked up a book on quilting and I’ve got a whole box full of fabric scraps.
Linus was right. Everyone needs a blanket.

3/15/2009

Using The Rainforest To Wipe Your Ass

Uncle AndrewUncle Andrew
Filed under: @ 11:17 am

Got this off of EcoGeek this week. This is something we were already aware of, but it’s nice that Greenpeace and the National Resources Defense Council took the time to lay it out all nice and neat for us, the toilet-paper-consuming public.

Plainly said, the average North American’s desire to squeegee their cheeks with the equivalent of a goose-down comforter is causing more ecological damage than all the Hummers on the road combined. That heavenly, pillow-soft bumwad is made from virgin timber, much of it harvested from the old-growth forests of places like British Columbia, Canada.

This is not merely¬†irresponsible; it’s almost literally obscene. Like smearing your waste all over an endangered shorebird before tossing it in the trash.

Greenpeace and the NRDC have put together a handy-dandy little flier (PDF format) you can print out and take with you shopping to help make wiser choices in toilet paper, tissues and paper towels. We managed to learn a little something new from this flier as well. We’ve previously ordered Seventh Generation products, but it turns out that Green Forest is slightly higher in post-consumer waste content, so we will probably move over to that.

And before you ask: no, using these products is not¬†like raking a piece of chipboard across your nethers. It’s not like blotting your bum with a baby harp seal either, but it’s perfectly acceptable for three seconds of dirty work.

So do your part, people: treat your seat with a little less indulgence, and the planet with a little more. Give a shit. :mrgreen:

3/11/2009

Our Long National Nightmare Is Over

Uncle AndrewUncle Andrew
Filed under: @ 9:26 pm

….by which I am referring, of course, to the fact that Chevron has finally decided to slip a ball gag over their screechy, hysterical petroleum pumps.

If you’re not a patron of Chevron gas stations you will likely not be aware of what I’m talking about, so here’s the skinny:¬†somewhere¬†around two years ago, the Chevron Corporation reprogrammed the software in all of its filling stations’ pumps via their satellite links. This is nothing unusual, happens all the time. Only this time, the Mother Ship decided to add a truly aggravating personality quirk to these otherwise generally inoffensive machines: an audio prompt.

Every time the message changed on the LCD display on the pump‚ÄĒ”Select Fuel Grade”, “Print Receipt (Y/N)”, etc.‚ÄĒthe pump would emit a squeal. A really irritating squeal. A tooth-rotting, soul-searing, carbide-circular-saw-blade-against-a-slab-of-roofing-slate squeal.

And it would make this horrible noise at every single prompt.

“Remove Card Quickly” *SQUUUEEEEEEEEEEEP* ; “Select Fuel Type”¬†*SQUUUEEEEEEEEEEEP* ; “Remove Nozzle: Begin Fueling”¬†*SQUUUEEEEEEEEEEEP* ; “Replace Nozzle After Fuaeling”¬†*SQUUUEEEEEEEEEEEP* ; “Print Receipt (Y/N)?”¬†*SQUUUEEEEEEEEEEEP*

And then, as a final punishment for the inexplicable error of my continued¬†patronage, “Thank You For Choosing Chevron”….*SQUUUEEEEEEEEEEEP*.

It’s as though the Chevron Corporation wanted to recreate the customer experience of dealing with the average contemporary retail counter-monkey, but the technology wasn’t yet up to the task of making an automated fuel pumping station quite that¬†unpleasant. Having the thing shriek at you at regular intervals throughout the transaction was the closest they could get.¬†More likely, of course, is the idea that this was some sort of efficiency measure on Chevron’s part. I assume that some piece of demographic data they managed to harvest suggested that they could shave pennies off of their affiliates’ monthly overhead by finding some way to push people through the process of gassing up with a bit more punctuality. I know that I myself have whiled away many an hour down at the ol’ gas hole,¬†chatting¬†with my pump-island neighbors, breathing deep to take in the heady aroma of expired dinosaur, and washing my rear windshield six or seven times just to hear the¬†mellifluous¬†sound of squeegee on wet glass. Good times, good times.

Of course, me being me, I sent Chevron an email about this new wrinkle some time ago. They responded in fairly short order, which I found quite gratifying. Less gratifying was the fact that they totally misinterpreted the intent of my communique. The person who answered the letter assumed that I was complaining about a faulty pump at my local Chevron station that was making an unintentional racket, rather than a policy on the part of the company as a whole to make all of their pumps keen like a pig in a wood chipper. Perhaps the pumps in this particular employee’s locale had not yet been subjected to this software “upgrade”. Perhaps Chevron employees over a certain rank don’t go to filling stations but instead replenish their vehicles from the massive solid-gold petroleum fountain in the lobby. Whatever her reason may have been, she sent me back a note letting me know that Chevron would contact the management of my local station right away and get to the bottom of this. I¬†briefly¬†considered responding to the note letting her know of her mistaken inference, but decided I would just be getting myself in deeper for little chance of a better return.

The next time I wen to fill up my tank, I could swear that the guy manning the counter was glaring at me.

Apparently, though, enough people have weighed in on the subject of being screamed at by industrial appliances to convince Chevron that they should rethink their strategy. Now the pumps only start to whine if you don’t follow a particular command within a predetermined length of time. This is certainly a step up from having one’s eardrums ruptured at every prompt, but it still leaves a lot to be desired. If Chevron really wants to get its customers in and out in a hurry, why not reward us for punctuality rather than punishing our tardiness? How¬†about, every time we manage to accomplish a task ahead of the maximum time allotted for same, a little door opens in the pump’s control face and we receive a yummy pellet?

That’s good behavioral modification. The kind that makes for repeat customers.

3/7/2009

Help A Buddy Out Here….

Uncle AndrewUncle Andrew
Filed under: @ 3:57 pm

Okay, so tell me I’m not the only one who does this,¬†because¬†if I am I might get a little creeped out with myself.

I had another of those long nasty marathon sessions at work the other day, overhauling‚ÄĒfor the third time in a month or so‚ÄĒthe goddamn mail server. Turns out the one we Frankenberried together was not doing well, producing random bluescreens that I was unable to pin down. I did everything I could to ameliorate the situation: swapped out the hard drive, replaced the RAM, installed a new power supply….nothing seemed to help. At some point you¬†have¬†to just throw in the¬†towel¬†and¬†pronounce¬†your efforts to have been for naught. Certain ASUS motherboards are known to have a reputation for capacitor failures, which may have been the case here, but even if I knew that this was the case it would leave me in much the same position. So we took the opportunity to retire one of our largely redundant servers and move its functions over to another machine, saving energy and waste heat in the process.¬†

Of course, the process of migrating our mail server to another PC, along with about 40 gigabytes of corporate mail, took us until around ten that night, so it was past my bedtime as I rolled outa Dodge, not to mention that we’d been at it for about ten hours so I was fairly bushed. I needed a pick-me-up before I drove back up to Seattle. Problem is, no coffee shops in the Olympia area are open at ten-thirty on a weeknight. So I was reduced to stopping at a 7-11 for a mammoth mug of their famous coffee-scented Toner Ade, beefed up with a half-dozen squirts of¬†high-fructose corn syrup¬†suspended¬†in a matrix of¬†partially hydrogenated soybean oil. If the sugar and caffeine don’t keep you awake, the acid indigestion sure will. I paid for my proto-joe and was on my way home.

As I rounded the on-ramp and merged onto the deserted lanes of Interstate 5, I brought my coffee to my lips. The lids for most hot beverage containers provided by commercial establishments tend to be constructed along similar architectural lines, the state of the art having been agreed upon some time ago: a foreshortened plastic dome, flattened across the top, with a single narrow hole through which one may pull draughts of coffee/chai/whathaveyou. This design maximizes the ability to access reasonable (i.e., enough to satisfy but not enough to vulcanize) amounts of beverage while minimizing the amount that can be spilled in the event of drops, bumps, fuel-truck rollovers with attendant dodging of flaming wreckage, etc. It has thankfully all but replaced that other, far less effective and structurally sound coffee cover: the flat lid of almost monomolecular thickness with the big perforated truncated-pie-wedge-shaped chunk removed, through which mouth-scaldingly large volumes of molten liquid can sluice with happy abandon at the slightest provocation.

The only real problem with the modern to-go coffee lid is that it can be difficult to find that hole on first application, particularly while driving. Such was my situation as I tried to get some of my caf√© laughable down my gullet and slathered all over my by-then highly attenuated nervous system. Even if I had been willing to take my eyes off the road, the inside of the car was dark and it’s highly unlikely that I would have been able to identify the tiny hole anyway, even as I careened off the road and flipped over the concrete barrier. I suppose I could have used a finger, but frankly, my hands had been in and out of manky computers all night, and I didn’t trust them to not leave their mark.

So instead I used the most convenient, motile and sensitive agent I had at my disposal at the time: my tongue. I ran the tip  around the edge of the lid until I found the hole. Then, with the tip still lightly inserted, I rotated the cup until I had it more or less sighted down the center of my mouth, dislodged it and proceeded to imbibe.

It was on perhaps the second or third enacting of this highly effective solution that it struck me to wonder if I was the only person who negotiates his travel beverage by essentially rimming it, or if anyone else has chosen this solution to the problem as well. So if you have, let me know. Please.¬† ūüėĮ

3/4/2009

Not Really Sure What To Make Of This….

Uncle AndrewUncle Andrew
Filed under: @ 2:20 pm

I had myself a really, well, interesting¬†dream this week, that I think might say a lot about me. But I don’t exactly know what. And I really don’t want to read too much into it either.

I dreamt that I had written a very well-received book about a woman’s adventures trying to keep her brother from going to Hell. Not in a detached, intellectualized sense, but as in Hell: the Pit of Fire. He was being escorted/led there by a devil who had apparently (it was not adequately explained in the dream) managed to trick the brother into following him on a fairly involved journey from wherever he was a the time to the actual, physical location of the Realm of The Damned. His sister enlists the aid of a family friend to try to head them off at the pass and convince her brother not to follow the devil into eternal damnation.

This is just the background story, and of no particular relevance (or revelance‚ÄĒha ha, get it?) to the rest of my dream. In my dream I was visualizing what the scenes leading up to the climax of the story would look like either on film (for it was sure to be optioned into a blockbuster movie) or in “real life”. So, in my dream I was following the real-time progress of the story at a point about three-quarters of the way through, only even as I did so I knew that I was just seeing in my mind’s eye what was transpiring in the story of a book I had written. About which I was dreaming. In real life. Like, this real life, right here. This one. Dizzy? Me too. Go get yourself a glass of water; I’ll wait.

So at this point in the narrative, the woman and the family friend (played in the dream I was having in my dream by me) have followed the brother and the devil across many states, no doubt through many trials and travails, and have somehow ended up in Heaven. The basic concept was that all souls traveling to one or the other of their Final Destinations must first pass through its opposite along the way. I’m not sure why that was; perhaps it’s a chance to see what you narrowly avoided/managed to miss out on before you get to your everlasting reward. Or maybe it’s meant to give you a tour of the workings of the Afterlife, like being taken through the kitchen of Buca di Beppo before you get to your table. Anyhow, the sister and I, in tracking the devil‚ÄĒnot The Devil, just a middle-management imp of some sort, an easygoing-looking guy dressed in casual prep‚ÄĒand his quarry back to Hell, had to first pass through Heaven.

Most of you are familiar with the conceptual device that says that human beings do not have the necessary sensory equipment to look upon things like Heaven, angels, demons, etc., in their actual form without going insane, having our eyeballs asplode, stuff like that. The idea is that, for mortals, these wonders must be presented in a form that our minds can grasp, or else that our minds generate their own, highly filtered and wildly inaccurate models by which we can perceive such things should we come across them.

Got that all? Good. So:¬†in the narrative of this dream I was having about my visualization of this blockbuster work of fiction I had written, my mortal mind was faced with the inconceivable grandeur and majesty of Heaven and chose to portray it as….a doughnut shop.

A really bright, clean, tile-and-stainless-steel doughnut shop.

Staffed entirely by industrious Japanese ladies. In blue smocks. And hairnets.

Big white boxes of doughnuts of every kind came sliding down a big stainless steel chute from a second level of the shop. At the bottom of the chute the ladies picked up the boxes and stacked them according to their contents. Customers came through the twin glass doors regularly, picking up boxes and leaving. No money changed hands, as far as I can remember, and no one ever placed an order or decided what they might like; they just walked up to the counter, were handed a box, and walked out the door, with the counter ladies bidding them enthusiastic farewell in Japanese.

The sister and I somehow managed to enter Heaven through the service entrance, as it were, on the second level. We needed to get to the door on Floor 1 in order to exit and make our way to Hell, so we made a serious mess of things by sliding down the chute, much to the horror of the mama-sans manning things at street level. Boxes of doughnuts flew out of the chute and plopped onto the spotless floor below. Our shoes left streaks of grime on the burnished metal surface, and when we came to a landing at the bottom we knocked over a six-plus-foot tower of boxes, sending fusillades of pastry flying every which way.

When we managed to pick ourselves up off the floor, we found ourselves being severely chastised in Japanese by the owner, a short, somewhat stocky man with a scraggly beard and mustache, wearing a white apron. Or perhaps I should refer to him as the Owner; because as you may have guessed, we were being dressed down by none other than God Himself.

As God excoriated us for causing such an uproar and making such an‚ÄĒahem‚ÄĒunholy mess, I used up my entire repertoire of useful and relevant Japanese: “Gomen nasai” (“I’m sorry”), I said and bowed deeply to Him, over and over. After a bit God’s tone got a little less heated, a little more gentle, and I dared to look up from my bowing. He offered one last piece of advice‚ÄĒthat, of course, I could not understand‚ÄĒand did me the profound honor of offering his hand. I shook it, saying “Arigato” and bowing. We got out of there as quickly as decorum seemed to allow.

Once we got through the glass doors, it was a few steps down before we made it to Hell. I’m sure there was some sort of transition from one place to the other, but I don’t really remember it. One thing I do remember is that it seemed important to the arc of the story that Heaven and Hell exist within sight, even within spitting distance, of each other. Perhaps so that one could look upon those poor souls/lucky bastards on the other side and use their experiences as a way to add further meaning and dimension to your own.

As we descended the steps, we crossed the threshold of Hell, which turned out to be….a barbecue joint.

A dark, murky, wood-beam-ceiling-and-leather-upholstery barbecue joint. With caucasian waiters. In white shirts and black pants. With filthy, grease-stained aprons.

We took a seat at a table, from which we could still see through the glass doors of Heaven, where customers continued to flow in and out of the shop with boxes of doughnuts. Just as a waiter approached us, I woke up.

I told all of this to Margaret as we sat in the hot tub that morning, because if I didn’t tell someone my head was going to pop off and fly around the room on a contrail of high-pressure dream runoff. She laughed her ass off through most of it. She also loved the idea of Hell as a barbecue place. But what she really wanted to know was, how was the barbecue?

“Um, I don’t know,” I replied. “I didn’t get a chance to taste it. I do remember that it smelled really good, but that there was something about it that seemed really wrong. Like maybe it was truly excellent barbecue but it was made from babies or something. I’m not quite sure”

Margaret thought about it for a bit. “Maybe that’s what Hell is like,” she mused. “Maybe all there is to eat is barbecued babies, but the sauce is really good.”

“Hm, maybe.”

“Or maybe,” she continued, “in Hell there’s only barbecue and you can eat all you want, but the barbecue is really mediocre.”

“Uh, I know you never went to Sunday School or anything, but, you do have a basic idea of what Hell is supposed to be, right? Lake of Fire? Eternal torment, et cetera? Do you really think that an eternity of lackluster entrees qualifies?”

At this point it was time for us to get about our day. We got out of the tub to get breakfast, and as I was handing her a towel she mused, “Or maybe in Hell the barbecue is really good, but the only sides left are the yucky ones, like creamed spinach.”

I have no idea what to make of this dream or what it means about me, really I don’t, save perhaps the startling revelation that I like doughnuts and barbecue. But one thing I have learned from this experience is: never ask my wife to interpret my dreams when she’s hungry.

3/1/2009

Why Veterinary Medicine is Uber Cool — Part Two

MargaretMargaret
Filed under: @ 5:11 pm

About six weeks ago I neutered a nice little black kitten named Jaws. In and of itself this isn’t unusual. On average, especially in the spring (I’ll get back to the ‘spring’ part later), I’ll neuter six or eight kittens in a week.

About a week after his surgery I got a phone message from Jaws’ mom. Jaws was acting cranky, he was hissing at his brother Moose, he wouldn’t play, and he was dribbling urine around the house.
Erm.
Well any report of ANY male cat dribbling urine around the house makes me anxious, regardless of whether or not I’ve recently had anything to do, however indirectly, with his plumbing.
I didn’t have any space in my schedule for that day so I had the receptionist call Jaws’ mom and instruct her to take Jaws directly to the ER so he could be evaluated.

Presently I got notification over the fax machine that Jaws had been admitted to the ER with a urethral (the urethra is that bit that hooks the urinary bladder to the outside world for those of you not in the know) obstruction. The obstruction had been relieved and Jaws was currently resting comfortably with a urinary catheter in place. Jaws would be discharged in a few days.

A brief pause to delve into the medicine part:
1. The urethra of the male cat is quite narrow and makes some very remarkable twists and turns on its path to the outside.
2. Male cat urine can tend to be very concentrated and occasionally, for a laundry list of reasons, they will start to form microscopic mineral crystals in their urine.
3. When the correct conditions are met (plenty of crystals, cat unable or unwilling to urinate for a period of time, under the correct phase of the moon the cat walked under a ladder while a black cat crossed his path etc. {these last two conditions are facetious by the way}) the crystals will form a plug, usually at one of the more tortuous turns in the urethra, and the cat will be unable to urinate. This, if you hadn’t guessed, is BAD NEWS.
4. The way we want treatment to go in these guys is as follows. With a moderate amount (depending on the size, location, and duration of the plug) of bad language a urinary catheter is placed and the bladder emptied and flushed. The urinary catheter is left in place for 48 hours or so to allow the bladder to rest after having been stretched out. After 48 hours the urinary catheter is removed and the cat is monitored for another 12-24 hours to be sure he can pee normally. Occasionally what will happen is that we remove the urinary catheter and start to monitor the cat’s urinations only to find that the urethra has been so irritated by the combination of the plug, the relief of same, and the urinary catheter, that it swells and the cat is unable to pee again. This results in further bad language.

And unfortunately this is what happened with Jaws. We got a tearful call from Jaws’ mom on the Wednesday of the week he had been admitted to the ER. Jaws’ urinary catheter had been removed, he had re-obstructed, and he either needed immediate surgery or he needed to be euthanized. She couldn’t afford the surgery and he is only a baby and she didn’t want to put him down and, and, and, and, and…..
There is a third option.
Sometimes, not often, but sometimes, you can replace the urinary catheter, keep it in place for another 48 hours or so, blast the bejeesus out of the cat with anti-inflammatory medications then remove it to find everything hunky dory. We offered her that option, she accepted.
Unfortunately it didn’t work.
We re-admitted Jaws on Wednesday afternoon and I replaced the urinary catheter. We blasted the bejeesus out of Jaws with IV fluids and anti-inflammatory medications for 48 hours and by Friday evening he could only sort of pee. Sort of.
I got a call on Friday evening from our office manager on behalf of my boss. The surgery the cat needed wasn’t, she knew, something that I’d done before, but would I be willing to give it a try? I’ve rather a reputation at my current hospital as a rather experienced surgeon and I’ve performed surgical procedures that the other two doctors wouldn’t come close to attempting. I like surgery, I like the cat, and honestly I felt sorry for the owner so I agreed.

The surgical procedure is called a perineal urethrostomy. You create a permanent opening (a stoma) in the urethra and have it exit the body in the perineal space, thus a perineal urethrostomy. It is technically a simple surgery, really. All you’re doing is basic deconstruction and so long as you know what bits of anatomy you’re dealing with and so long as you can sew it’s simple. I’ve read the procedure several times, I did a whole bunch of research into possible complications. There are a large number of potential complications and the bottom line is that when something like this goes wrong, it goes wrong in really ugly ways.
I must have done the surgery in my sleep dozens of times overnight on Sunday so that by Monday morning I was completely keyed up and, from having read afresh the rafts of “oh my god it all went pear shaped” posts regarding PU surgeries on my online vet site, was thoroughly convinced that there was no way that this wasn’t going to make me absolutely miserable. BUT I’d agreed to do it, I’d put my reputation on the line, and really there was no other option but euthanasia for the cat so……

So I re-plumbed the cat. I won’t go into details because it’d gross too many people out, but whatever I did seemed to work. Jaws was up and about that afternoon not only able to control his urination, but able to empty his bladder completely. Jaws was making happy feet (I believe in STURDY postoperative pain control) and eating by the time I left that evening.
And he came back to have his few remaining sutures removed about a week ago. Happy, purring, peeing like a champ, and growing the hair back along his shaved little baboon butt.

Veterinary medicine is so cool.


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