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.