Optimism and Stretch

Life is funny. Except it’s not. Life is difficult and many of the lessons you will encounter arrive as stressful and sometimes painful experiences. Here’s the thing about that. It’s important to stay optimistic and it’s even important to embrace things that you don’t feel like you can accomplish. Embrace them with optimism. No matter how it turns out, you probably ought to be facing it anyway and you’re going to learn something important.

Don’t be afraid to stretch yourself. Yes, it’s important to know where your line is. But it’s also important to flirt with that line every now and again to improve yourself as an individual and a professional. Most of the experiences I think back on when I think about how I’ve developed over the past few years and decades were experiences I was not ready for and not really equipped to handle.

Below are three stories from my first few years in practice that stretched my abilities and stressed me out but ultimately taught me a lot about patient care, client communication and personal development.

1. The dog was an epileptic. We knew that. When he had seizures he usually had them in clusters. We had him fairly well managed for the most part up until that night. He came in actively seizing and wouldn’t come out of it. We call that status epilepticus. He didn’t respond to several doses of anti-convulsant medication but we finally put him under anesthesia with a drug called propofol, you might have heard if it. Thanks a lot MJ.

As soon as the propofol wore off he went directly into seizing again. Propofol is a short acting drug, it can be formulated into a constant rate infusion but it also has a narrow margin of safety and if given too quickly patients stop breathing and if no one is there to respond they might not start again.

The concern with constant seizures is that they cause damage and lead to more seizures. Dogs can end up blind or worse. I had recently read a paper that described using a drug called ketamine as a constant rate infusion to control status epilepticus in a dog. The tricky business there is that ketamine at certain doses can cause seizures and at lower doses it won’t stop the seizures, only make the patient more restless and disoriented. But still, there are some significant neuroprotective benefits to using ketamine in patients undergoing seizure activity, especially extreme seizure activity.

I had a conversation with the owner and explained that I had never done this before but there were some benefits that would fit their dog’s condition perfectly and that it would be better than using propofol. They understood and agreed with me and we set it up. I stayed and watched over him for a few hours, ignoring my wife’s text messages until she finally just went to bed. The overnight technician finally convinced me to go home.

There was no seizure activity over night. The next morning we turned the infusion off, the dog was groggy but slowly regained his ability to walk and move around. He stayed seizure free and went home that afternoon. I have since used ketamine to control status epilepticus in a number of dogs and have very good results with it.

2. The owner had called and said he was pretty sure the stick was in her lungs. A 10 month old German Shorthaired Pointer had been playing rough outside and had impaled herself on a stick according to the owner. He was already on his way. The owner arrived carrying a dog carrier/ He placed it on the table and a visibly frightened puppy stepped out of the front. She had her head hung and looked weak. Then she took a breath. A spray of blood and foam came out of the three inch hole in her shoulder. I clamped a hand over the wound and tried not to show my panic. I’m sure it was pretty clear. This dog had a penetrating chest wound and there was nowhere to send her. I used a few clothespins to hold the wound closed while I sorted out what we were going to do next.

We placed an IV line, took some preliminary x rays and got her into surgery right away. Once we had an endotracheal tube in place, someone could manually breathe for her and the waves of panic reached their high water mark and started to ebb back into something that resembled calm. We opened up the wound to about twice its original size so that we could surgically explore the site. We removed as much stick material as we could find. As we closed the surgery site that had once been a wound, one staff member held the lungs inflated while I placed the sutures as quickly as my hands would move. This would help to be sure there wasn’t much air in around the lungs while they did their job.

Once the wound was closed, we placed a tube into her chest to draw off any excess air. It would stay in place until no more air could be drawn off. The overnight technician stayed with her and her evening was uneventful.

The dog went on to make a full recovery. I have gone on to place more chest tubes than I can remember right now.

3. I looked in the box at the cat, she was bright yellow with jaundice. The cat barely lifted her head to look back at me. As a general rule, jaundiced cats don’t typically survive. The cat had been bit by a dog in the groin area and the fat around that area had become necrotic. Necrotic fat sort of liquefies and spreads out under the skin. It’s a disgusting mess. The cat was septic, meaning an infection had entered her blood stream. She looked pretty bad off.

The trick to dealing with sepsis is lots and lots of fluids. You sort of over-hydrate them to dilute and flush out the endotoxin chemicals produced by the bacteria and the inflammatory mediators produced by the body. The other thing about dealing with jaundice in cats is that they need to receive nourishment. Need to as if their lives depend on it, because they do. Any jaundiced cat without a feeding tube is courting the idea of being dead. A jaundiced tube with a feeding tube can still die but one without a feeding tube is way more likely to. So our kitty had an IV line placed for fluids and then a feeding tube for nourishment. Then she was started on a regimen of antibiotics, feeding and pain management.

Eventually all of the skin along her underside sloughed off leaving bare muscles and connective tissue exposed. Several procedures later we were able to limit the exposed tissue to just her abdomen. Still feeding and giving fluids aggressively. Eventually, she started to turn the corner. We were able to assist her skin growth by packing the wounds with sugar and eventually the yellow color faded from her eyes, skin and gums. When she started eating on her own and we were able to remove the feeding tube, we knew she was going to be alright.

After several more days of sugar bandages and eventually leaving the wound open to the air, we were able to send her home. She went on to completely recover from her ordeal.

Any one of those situations might have gone differently had our team not kept a positive outlook or had we retreated back from the problem and said, “We can’t handle this.” In truth, not a single one of those situations was handled perfectly. There were shortcomings in every single one of them. But we recognized them, learned from them and are better for having the experience. Most importantly, our patients were well cared for and received the best care we had available to offer them.

I hope that life continues to throw challenges at me that will stretch my abilities and I hope that I embrace them with the same optimism that has allowed me to get so much out of these experiences so far. I hope the same for you.

Thanks for reading.

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One thought on “Optimism and Stretch

  1. Pingback: Optimism | Vetcha

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