Saturday, April 26, 2008

Last night was R-O-U-G-H, rough!!

My first patient was there last night before I was!! A miniature schnauzer - owner picked him up from the groomer's and he escaped as she tried to put him in her car - ran out into the highway and got smacked by a car... uh, hello!! That's what LEASHES are for!! Anyway, he's completely neurologic, and worsened through the night despite the mannitol, furosemide and dex.... I really think we're talking permanent brain damage here - when I left he was panting/whining continually and he is completely non-responsive unless you really shake him and then he vocalizes louder but he does not *focus* his eyes, kwim?? Lights might be on but no one is home.... Not to mention the dislocated shoulder (which I couldn't reduce because he's not stable enough to anesthetize as deeply as would be needed to reduce it), the fractured fibula (which is no biggie) and the sacro-iliac subluxation... He can't maintain his body temp without the Bair-hugger, and I don't think that's just because of the morphine, though his owners (understandably) would like to attribute his diminished mentation and low body temp to it. They can't wrap their minds around euthanasia at this point - which is fine - so we're going to try to maintain him through the weekend and see if we get any improvement. I'm praying for a miracle for the little guy. I guess stranger things have happened, right??

It was just a crazy night!! I got another HBC a bit later - a big hound with a distal humerus/ulna fracture, a nasty proximal tib/fib fx with fragmentation and compression, along with some fractured metatarsals; this dog needs MAJOR reconstructive surgery, which these owners just aren't going to do. They left the dog with us last night and then were unavailable at any of the phone numbers that they gave us. They only paid for one night, so if we can't get up with them today, I'm guessing that I'll be doing a humane euthanasia tonight when I go back in - I cannot see making that dog suffer through the weekend for nothing... and since they only wanted to leave her one night to stabilize her (and they did THAT reluctantly), they HAVE to come back today. Given that she's in so much pain, we can claim abandonment pretty fast if we can't find them... she's such a pretty girl - but they haven't even bothered to vaccinate her, so what are the chances that they'll go for a very expensive surgery and prolonged recovery?? The first thing out of the wife's mouth when she brought her in was "we were going to get rid of her." That does not bode well for the poor baby!!

Then there was the 6 month old poodle puppy with the broken tibia; it was already broken once and had been pinned in January; the woman's grandson dropped her tonight and broke it AGAIN... there was the fear-biting Great Dane with the laceration to her butt (no biggie - sedated her, clipped and scrubbed it and threw in a few staples), the beagle with the thru-n-thru bite wound to the face (I had to sew up the outside AND the inside of his lip, and then reattach the chunk of gingiva that was torn loose), the dog bite to the ear (the puppy had a 1/2" long laceration and was already going to the regular vet TODAY for vaccines, but his "daddy" wanted the ear stitched up at 3am), the 14yr old dachshund - mean, obese, icteric, ALT/GGT off the scale, urine was dark red in color, not eating, lethargic, HCT of 10% (!!) - she actually collapsed when we went to draw blood!! At least they decided to euthanize her after a couple of hours!! Hmmm... what else did I see?? Oh, yeah - the constipated Lhasa... that dog's "story" changed every 5 minutes, depending on what specific questions I asked the owner - they didn't tell me until AFTER the x-ray that the dog has a history of constipation, that she had seen the dog straining to defecate the day before, AND that the dog hadn't pooped in at least 3 days!! Yet they WONDERED why the dog's belly was hurting?!? Are people seriously this stupid? Yes, they are!! Not to forget the 6wk old German Shepherd puppy with coccidia, roundworms, hookworms and PARVO! I was pleasantly surprised that they opted to leave that little guy, even though they DID opt for the minimal amount of treatment - at least they are doing SOMETHING!! I think that about covers it - I didn't get one single cat in last night... I just now realized that!!

Anyway, I got to "bed" at about 3:30 this morning, but had trouble going to sleep; I slept from about 4 until 6:30, then from 10am until 1pm after I got home this morning. I've got to get a shower now so I can get a few things done before I head BACK to AUC tonight... I think it will take a little getting used to - this switch from day practice to emergency (primarily night) work, but I really enjoy it, so I'll adapt. I just need to get used to being tired! LOL