Two trips, a holiday, and a birthday

Wow guys, it's been awhile since I posted last, sorry about that!  Since the last post I've gone to Santa Fe, celebrated July 4th with a rainstorm, gone to Lake Powell, turned 25, and finished out my last solid week of work here in Window Rock.  It's crazy, I can't believe I've been here for a month!

So on June 30th Cheyenne and I packed up and made the 3 1/2 hour drive to meet my mom and 3 of her friends in Santa Fe, NM for the weekend.  It was a nice relaxing weekend full of window shopping, flea market shopping, and eating at delicious restaurants.  Thanks for the girls weekend Mom, it was a blast!  That weekend also brought the birth of our family friends, Mark & Linda Riederer's, first Dexter calf.  This particular long-legged calf required much coaching before nursing appropriately, much to Mark's dismay.  I think some gray hairs may have sprouted on Mark's head as a result of this calf's discombobulated sense of anatomy.  No worries though, the calf finally stooped low enough in the end!  On our way back to Window Rock, Cheyenne and I stopped in Albuquerque to run a few errands.  Sine these errands proved to be rather exhausting, it was a beautiful day, and we had no agenda, we stopped to play a game of fetch and take a nap under a tree.  It sounds whimsical and silly when I write about it, but in actuality it was really really nice and relaxing.  If you get a chance to take a nap under a tree someday I hope you take it!  The view:

Nap time under a tree.  Highly recommended! ;)

The next week consisted of 2 work days and 3 off days, plus the weekend.  Gotta love flip-flopped weeks!  On Monday (7/2/12) evening Cheyenne and I went to the Window Rock monument to enjoy the sunset, which, of course, was beautiful...

On Tuesday, BaaBaa, the 9-day-old, broken-legged lamb came in to the clinic.  After radiographs it was evident that her right front leg was certainly broken--directly through the metacarpal growth plate.  Perfect.  Time to phone-a-friend! This time it was Drs. Dominguez and Roussel.  With their blessings I put a cast on this lamb and told her owner that she must return first thing Monday morning to have the cast removed.  I was nervous because we typically don't like to leave fully-circumferential casts on for more than 2-3 days, especially in young animals.  This one would be on for 6 days because we were closed for the holiday.  On Monday, the 9th, they came back for cast removal and the leg looked great!  It was straight with no evidence of casting complications (infection, thrush, compression sores, etc.)!  I think I did a happy dance and thanked God for keeping the leg healthy.

Aside from laundry, clearing out my inbox, and going to the movies with a couple friends, I did a whole bunch of nothing on Wednesday, the 4th, and Thursday, the 5th.  The vet clinic here in Window Rock is located ON the fairgrounds and, since it was the week for 4th of July, the carnival had descended upon the fairgrounds.  Needless to say, the vet clinic was exceptionally difficult to get to.  On the 4th, I snuck onto the fairground premises, avoiding parking fees, and locked myself in the clinic to take advantage of free wifi and wait for the fireworks show.  The fireworks were scheduled to go off right behind the clinic after the rodeo finished up.  I was gonna have front row seats.  For free.  Yes!  Little did I know that Mother Nature had different plans.  The rain started as a drizzle in the middle of the rodeo, then the wind picked up.  By the time fireworks were scheduled to begin everything was so wet that lighting a fuse would require a blowtorch.  And maybe a bucket of lighter fluid.  So...I had my first July 4th with no fireworks show.  Womp womp.  I'm looking forward to the fireworks at New Year's!! (Irony note: my iheartradio is playing Katy Perry's "Firework" as I type this.)

On Friday, the 6th, Cheyenne and I drove out to Page, AZ to meet up with my friend, Devin, for a weekend on the lake.  Lake Powell is marvelous.  It makes no sense to me.  It's warm, gorgeous, blue water and soft beaches are surrounded by sandstone cliffs out in the middle of the desert.  We spent the weekend camping, napping on the beach, getting tan (or horribly sunburned), and driving to picturesque places.  We also went to the grocery store in town at least once daily for items we forgot to bring/buy.  (That little tid-bit is for you, Lauren Quast, lol).  Devin and Cheyenne played fetch for hours on end, we went down to the beach at night and debated on the location of the Little Dipper, and we made friends with one of the park rangers, Leonard, who told us his life story.  It was perfectly relaxing.

Lake Powell, Glen Canyon Dam is to the right of the frame

Horseshoe Bend.  A 15-minute drive + 10 minute hike from our campsite.

Can you see those 3 tiny specs down on the sandbar? Those are fly fisherman.  Just for perspective.

Devin at Horseshoe Bend

Cheyenne couldn't contain herself

Next time I go to Lake Powell I'm hoping a house boat will be involved.  Exploring the slot canyons by boat is supposedly the way to go!

The last week at work proved to be just as interesting as the previous weeks.  Monday brought in my first equine lameness case (bowed tendon of the right front).  I didn't handle it well.  It didn't help that cell phone service was a complete tease that day and thwarted my attempts to call for guidance.  After a couple hours, a few treatment plans, and several apologies, the horse and her owner loaded up and headed home with bute (an anti-inflammatory pain killer), salve for a sweat wrap (nitrofurazone + DMSO), and at-home care instructions (hydrotherapy and stall rest).  I was afraid the owner would be annoyed by my inexperience and insecurity, but after I apologized and admitted that I had spent a lot of time trying to think of what someone else would do, his facial expression softened.  He said "It's okay.  But I came here for your opinion, not someone else's."  Noted.  I'll try to remember that next time.

Tuesday was a special day.  Everything was perfect that day!  The two scheduled cat spays went well and all the walk-ins were manageable.  When I was in the middle of my first surgery of the day (pregnant cat spay), Carm, the head technician and my leading cheerleader out here, asked me if I had plans for lunch.  Nope.  She approved and informed me that lunch reservations had been made at the Mexican restaurant in town.  The office was taking me to lunch for my birthday.  I couldn't stop smiling under my surgical mask :)  My silly grin and welling sense of appreciation for these people grew even more when I realized lunch was not the only thing they were giving me.  I walked in, sat down at the table, and was presented with several unforgettable gifts.  Carm and Sowa gave me a beautiful shoulder bag and silver/turquoise earrings, Meranda gave me yellow shell earrings, Mia gave me silver/turquoise earrings and a necklace, Glenda gave me a cosmetic bag (which coincidentally matches the shoulder bag), and Ashley's uncle made 2 cheesecakes.  Then the whole restaurant sang "Happy Birthday" to me as a flashy sombrero was plopped on my head.  When we got back to the clinic, Carm brought her little brother into the office so he could sing a Navajo birthday song to me.  It was so neat!  Not to mention all the phone calls, text messages, and facebook messages from all of you.  Thank y'all so much, I felt really special for my 25th :)

One of my birthday afternoon walk-ins was Olive, the pregnant Chihuahua who had been in labor for over 15 hours and only produced one puppy.  We took an abdominal radiograph and, sure enough, one puppy was left behind.  When puppies (or kittens, or foals, or...) come out of the birth canal they should look like Superman--front feet forward, head forward, and cape blowing in the wind.  This puppy wanted to be different.  She was trying to come out sideways.  Rib cage first.  Not gonna work.  I informed the owners of this puppy's plight and said that spaying Olive was the best option, and unfortunately, since she had been in labor for so long, this puppy was probably a goner.  They were okay with that, they just wanted Olive to be happy and healthy.  The surgery was considered an emergency and ran after hours.  Just so you know, after hours work is NOT usually done at this clinic.  I, however, was simply thinking about getting this puppy out and gave no consideration to the timing.  Sowa decided she could stay if I could give her a ride home (30 minutes away).  I was happy to have help and gladly agreed.  Olive's surgery went perfectly!  A lot of people don't like doing surgery on pregnant dogs/cats, but I'm finding I actually enjoy it!  Its a lot easier to see important structures.  I handed the puppy-filled uterus off to Sowa, encouraged her to extrude the puppy as a learning experience, and went back to work on Olive's closure.  Then I heard Sowa pipe up.  She said "Uhh, Doc?  I feel a heartbeat on this puppy." What??? Unbelievable!  Well, wish I had taken that possibility into consideration when I came up with the sedation/anesthesia protocol.  Great.  This puppy was gonna be sleeping for awhile if she survived.  I told Sowa to gather a suction bulb, Dopram, and a few huck towels, and delegated neonate-care instructions to her from the surgical suite.  She did awesome!  The puppy never breathed for her but the heartbeat remained consistent.  By the time I finished with Olive, Sowa expressed that she was tired of working on the breathless puppy.  I grabbed a tuberculin syringe to clear the puppy's airway since, apparently, there is no suction bulb in this facility, slung it a few more times, and rubbed it vigorously before it started squealing in repugnance.  After another hour of prodding and encouragement, the puppy perked up enough that I felt comfortable leaving her with her mother and brother.

Happy birthday baby girl!  You were born on a good day ;)

The next morning the owners came for Olive and her original pup.  Their faces were priceless when I told them they were gonna have to make room for another puppy...I may as well have told them the Beatles were coming to Window Rock!  The grandmother expressed abounding gratitude for the level of care provided to Olive and her puppies and for my willingness to perform the surgery after hours.  I wanted to spend all day with this family, they were absolutely lovely.

The rest of the week went rather smoothly too.  I'm really going to miss this place.  Not enough to accept any of the job offers I've received though.  Glenda asked if I'd be interested in a job here at the Window Rock clinic, and then Dr. Jensen, a veterinarian in Gallup, whom I called for a second opinion on a big dog-little dog fight case, asked if I would be interested in taking over his whole practice.  Sight unseen.  Craziness.  I've never known what it's like to be a commodity before!

This weekend was spent avoiding packing, avoiding writing this blog, and hanging around Window Rock.  Tomorrow is my last day working at the clinic.  I have mixed emotions about this.  I don't want to leave these people, I want to take them everywhere with me!!  On Tuesday, I'll be one of two veterinarians speaking at the Rocky Mountain Spotted Fever summit meeting.  Doesn't sound like much, but the CDC (yeah, Center for Disease Control) is coming here to back us up while we present to the tribal counsel the need for pointed efforts against Rocky Mountain Spotted Fever.  Public speaking...my favorite.  Wish me luck!

I'll try to blog in the next couple days.  Maybe some of y'all should hold me to that...

A Week of Firsts

This past week was a whirlwind! It seemed like an endless journey at the time, but now looking back on it, trying to recall the details, it all seems like a blur. I remember events from Monday and Friday...Tuesday, Wednesday, and Thursday, however, all smudge together into "mid-week". I think I'll call it: Tuenesursday.

On Monday morning I walked into the clinic, bright-eyed and bushy-tailed, ready for the week to come. I was surprised at how smoothly the morning seemed to be going, it was refreshing! I soon realized it was because we had no surgeries scheduled for that day. The rest of the day, and week, really, was characterized by a hodgepodge of walk-ins.

Monday brought in my very first ovid patient, a Columbia-cross ewe named Mary. It was clear from the blue nylon collar, the clangy cowbell, and the attendance of the entire family at the appointment that she was a beloved family pet. All I could think was: don't mess this up, don't mess this up, don't mess this up. She had been losing weight and lagging behind the rest of the herd for the past 2 months, not to mention the development of a horribly distended abdomen over the past 3 weeks. The owners mentioned that she lambed 3-4 months ago but they never actually saw the lamb. It must've been eaten by a coyote. They had no idea what was going on with Mary, and frankly, neither did I.  All I knew was that her udder was indistinguishable from her rotund abdomen, she was a body condition score 3/9, and she was otherwise clinically normal.  Great.  I did a physical exam, decided to determine whether or not her cervix was open, and performed a trans-abdominal and rectal ultrasound exam.  That gave me enough information to excuse myself from the appointment and frantically call for guidance.  My phone-a-friends for the hour were Dr. Roussel and Dr. Parsons—two veterinarians who gladly lent their expertise.  With their help I was able to conclude that this was likely a case of a mummified fetus.  You see, sometimes, when birthing goes wrong and babies aren’t actually produced, it’s possible, especially for ruminants,  for the fetus to stay inside the uterus for an undisclosed amount of time and turn into a dried-up, prune-like, mummy.  If the mother stays systemically normal, the prune is called a “mummified fetus”, if it makes her sick, it’s called a “macerated fetus”.  Mary was lucky.  I gave her one injection to help pass the fetus (Lutalyse) and another to ward off infection (LA200), instructed the owners to provide her with plenty of food and water, set up a re-check appointment for 2 weeks later, and sent them on their way!  I’ll let you know how everything turns out once they come back for their re-check.

Juno, the middle-age, hit-by-car dog who I referred to in my last post, was another patient from Monday.  She had been struck over the weekend and had to travel 70 miles with her owners to the Window Rock vet clinic.  After radiographs and an exam were performed, it was obvious that she had a significantly fractured pelvis and a nasty flesh wound on the back (caudal) part of her right leg.  Unfortunate, albeit manageable.  I assured the owners that this was fixable but it would take patience and keeping Juno confined for a couple of months so her pelvis could heal.  The owners toiled with their decision--their whole family was saying to just euthanize Juno and I was telling them it was fixable with time.  Ultimately, they left Juno at the clinic for wound treatment through the week (and it's healed marvelously!) and decided to build her a confined area at home where she could heal over the next couple months.  I was so touched by the committment they had for this sweet dog, it seems to be a rarity on the reservation due to money, time, and anti-fencing constraints.  I was also tickled pink over the improvement of her wound over the week!!  If you're squeamish, look away now.  I'm so proud, I have to share this.  It's my first time to realize that my intervention directly benefitted a patient!:

Juno with the "cone of shame"

Before: Day 1

After: Day 5

In the Tuenesursday of mid-week I witnessed my first desert thunderstorm.  It was breathtakingly beautiful and an experience I hope never to forget.  The energy, colors, and sounds produced by the clouds were an awe-inspiring display of God's love for the desert and it's people.

The latter part of Tuenesursday brought in my first colic patient.  Colic's are relatively routine in large animal practice.  Some vets love 'em, some vets hate 'em.  I've always just been terrified by the idea of them.  This particular gelding had been missing for two weeks (he didn't come back when the owners turned him out into an unfenced area to graze) and was found Thursday morning at a neighbor's house.  This poor horse had dropped from a reportably healthy weight down to a body condition score 2/9.  His name was Tii, which is Navajo for "horse", and he was definitely in bad shape.  His heart rate was 88 beats per minute (normal for a horse is 30-40) and he only had gut sounds in 1 quadrant--definitely colicking.  For those of you who don't know, there are two major flaws in horse anatomy and these two things are what provide job security to equine veterinarians: their feet and their guts.  When one of those goes bad you're in for a sizable investment.  After much ado trying to pass the nasogastric tube (one of the 4H guys had to finally come help me...little did I know that this fully grown horse would require a foal-sized tube) it was determined that a small intestinal obstruction was not the reason for Tii's ailment.  Time to, again, phone-a-friend.  This time it was Dr. Crouch who brought calmness and patience to my frantic mindset.  Together we decided that Tii's colic was due to intense starvation...his GI tract had simply shut-down.  We placed an IV catheter, started him on a fluid bolus, and sent the owners out to get feed and bedding for his hospital stay.  I noticed later, as we were offering food and water, that he kept nosing the water bucket and turning away from the food.  My initial thought was "Well that's weird.  I would have my face submerged in both buckets at the same time if I were as starved as he looks."  I carried on with the fluid therapy with later thoughts like "Maybe he's just so happy to have water that he's playing in it" and "Maybe he doesn't want me to hand-feed him, maybe he wants to eat at his own pace."  Silly me.  When will I start to listen to my first gut instincts??  I told Glenda, one of the brilliant minds at the clinic, about Tii and his strange behavior and she asked the obvious question "can he actually prehend the food?".  Ha!  Can he actually prehend the food? What a silly thing to ask!  The owners said he drank 10 gallons of water before coming in, of course he has prehensile abilities!  Then she walked over to Tii and pulled out his tongue.  And there it sat. Just sticking out of the side of his mouth like a giant piece of pink taffy.  This, my friends, is a tell-tale sign for neurological impairment of the tongue and muscles required for swallowing.  Glenda, you are brilliant!  She mentioned that Russian knapweed, a toxic plant which causes these symptoms, grows rampantly in the area.  After doing some research I found that the plant is tastiest in June, especially to horses, and it leads to liquifactive necrosis of the nerves associated with food prehension, just like Yellow Starthistle in Texas.  All of this is to say: poor Tii had an irreversible condition and would never be able to eat again.  I called the owners to inform them of Tii's fate and told them we would wait to euthanize him in the morning so they could come say their goodbyes.  Unfortunately, Tii is also my first patient who died prematurely despite my best efforts.  I walked into the barn on Friday morning with a sinking feeling in my stomach when I realized my patient wasn't standing in the stall.  He had expired overnight, likely due to a fatal combination of stress, hypoglycemia, and muscle wasting.  His poor body couldn't handle it anymore and I just felt awful for the poor guy.  Again, I called the owners.  She was already on her way.  When she walked into the barn my first instinct and action was to walk over, hug her, and apologize.  She hugged me back and continued hugging me after I released.  She said "It's okay, I know you did your best and I thank you for that."  Another first: receiving praise from an owner when I feel like I went about everything all wrong.  Wow.  Humbling.

Friday was also my first time to castrate a horse, diagnose deep pyoderma in a dog and convince the owner that their dog needed to receive 6 weeks worth of antibiotics, and have an owner blame me for something erroneous simply out of personal frustration.  All-in-all, it was a very productive day!

The biggest thing though, was that this week was my first time to be a solo veterinarian at a practice.  I couldn't have done it without the support of the brilliant veterinarians who are just a phone call away and a staff that constantly has my back when I need them.  Each day brings new experiences which remind me to be appreciative, humble, and joyful for my lot in life.  I'm so thankful to be in a place which is forcing confidence upon me.  It's a personal hang-up of mine that is slowly being chipped away at on a daily basis.