“What kind of food does Snowflake eat?” Kim asked.
“That’s the problem,” Margaret answered. “He’s not eating. I’ve tried all of his favorites.” She stroked his head with her finger. “He sniffs the food like he’s hungry but then walks away.”
“When did this start?” Kim asked.
“Let’s see; I had my neighbor watch him for a week while we visited the grandchildren. He wasn’t eating well when we returned. I didn’t think much of it because he doesn’t like it when we leave. But we’ve been back for a week now, and he’s still not back to normal. He hasn’t eaten anything in two days.”
After a few more questions, Kim placed a towel on the table and motioned for Margaret to place Snowflake on it. She checked the color of his gums, measured his heart rate and listened to his lungs. Then she took a thermometer out of the drawer. She placed a generous amount of lube on the tip and inserted it into his anus. Normally, cats hate this. They yowl and try to get away…unless the cat is a female in heat. But Snowflake rested on the towel without moving. Kim waited for the thermometer to beep.
Finally, it did. The digital display read 97.7, below normal. Kim recorded the temperature in the record and highlighted it with a yellow marker. She folded the loose end of the towel over Snowflake to keep him warm.
“Dr. Nelson will be here in a minute,” she told Margaret calmly as she left the room.
Back in the treatment room, Allie held Mari in her arms. I cleaned a small area of skin on the puppy’s back leg with rubbing alcohol. She pulled the leg back when the cold alcohol touched her delicate skin. Next, I scratched the area with my fingernail to deaden the nerve endings and then gave her a shot. Mari yelped when the needle pierced her skin.
“Hey, quit torturing that puppy,” Kim commanded as she entered the room. She extended her arms toward Mari, but Allie wouldn’t give her the pup. Allie rubbed the injection site while cuddling Mari close to her chest.
“Your next patient is a sick cat, Dr. Nelson.” Kim handed me the record. “His mucous membranes are yellow. I’ve never seen one this bad before.” I took the record silently, hoping Kim was wrong.
Unfortunately, she wasn’t. When I examined him, all of Snowflake’s skin was yellow. Based on his history, I suspected a condition called hepatic lipidosis was behind the jaundice. When cats don’t eat, their bodies metabolize fat for energy. The liver responds by cleaning the excess fat out of the blood stream. Over time, the fat disrupts normal liver function, causing a host of other problems. Bilirubin accumulates in the cat, turning the serum yellow. If not treated, the cat will die from liver failure.
“Is it treatable?” Margaret asked after I finished my explanation of jaundice.
“Yes, hepatic lipidosis can be reversed by getting the cat to eat.” I took a deep breath. “But that’s easier said than done.” I paused to think. “Right now, Snowflake feels terrible. He’s nauseated, and his abdomen hurts.” Margaret leaned forward and wrapped her arms around her cat. “First we need to work Snowflake up to see what caused him to stop eating.”
“He stopped eating because we left him,” Margaret responded. “It’s my fault.” Tears glistened in her eyes. She buried her face in the towel covering Snowflake.
“I actually hope that’s the reason, Margaret,” I said. Margaret jerked her head toward me. “It could also be dental disease causing mouth pain, nausea from another problem like an inner ear infection, pancreatitis, inflammatory bowel disease, or even cancer. Of course, we’ll hope for something simple to treat.” I paused to let Margaret respond, but she sat frozen in place. “Sometimes we never know what caused the anorexia,” I added.
“I want to do whatever it takes to save him. He’s my baby, and I love him,” she whispered.
“The first step is to take X-rays and run lab work. Snowflake will stay in the incubator while we wait for the results. I’ll also give him IV fluids to correct his dehydration.” I put my hand on Margaret’s shoulder before continuing. “We’ll do everything we can to make him feel better.” I smiled reassuringly. I hoped it would be enough.
Chapter 3
Yellow Cat
After a busy morning of appointments, I headed into the office to grab a sandwich from my work bag. Lunch would be a few bites of a peanut butter sandwich in between surgeries. I closed the door behind me and changed into bright green scrubs. Genny slept on the desk chair, opening her eyes once to see who dared enter her domain before falling back to sleep. Every morning she hopped around the clinic, rubbing her face on doorjambs, chairs and cabinets to mark them. With that task complete, she checked out the hospitalized animals before heading to the office for a nap. She would probably be sleeping in the same position when I returned from surgery. Oh, to be a cat.
While Allie and Kim prepared Goliath, I reviewed Mari’s X-rays. I spotted two fractures in her paw, the third and fourth metacarpal bones. The fracture lines crossed the bones on a slight diagonal line in what is called an oblique fracture.
At veterinary college, my radiology professor taught us to look at X-rays in a systematic fashion to make sure we didn’t miss anything. I reviewed the film again, starting at the wrist and working up toward the elbow and then down toward the toes. Since Mari was a growing girl, all of her growth plates were open at the ends of her bones. I inspected each one for damage that might impede her growth, finding none. Mari’s fractures were in the middle of the metacarpal bones, away from the growth plates. That was good. The breaks should heal with a splint. I dialed Bill’s number on the phone in the treatment room.
“Hello, this is Bill Howard,” he answered.
“Hello Bill, Dr. Nelson calling.” I heard him gulp on the other end of the phone. I launched right into my message. “Mari’s injury isn’t too bad. She broke two bones below her wrist. They should heal with just a splint. She’ll need to wear it for eight weeks, though.”
“What a relief. I was worried you would have to…” he stopped without finishing his sentence. “Are you sure?” he asked again.
“Well, I can’t give you a guarantee but I’ve treated many puppies with this problem, and they all made a full recovery. I’ll splint the paw to keep it still. No wild running around at home. You must confine her to a crate to make sure,” I instructed. “Since she’s growing, I’ll need to change her splint every week. We’ll X-ray the foot at four weeks to see how well the fractures are healing.”
“When can she come home?” he asked. I could hear other voices in the background.
“Any time after 4,” I replied.
“Great, I’ll pick up the kids first, then stop by to get Mari. Anything else I need to know?” he asked.
“Not for now, but I do have one question for you,” I responded. “Why was your daughter so upset?”
“I lost my wife to breast cancer a few months ago. On our last visit, we said goodbye, expecting to see her the next morning. She passed away during the night. Lizzy is afraid to say goodbye to anyone because she thinks they will die.” He paused. “You said goodbye.”
“I’m so sorry, Bill,” I said with a gasp.
“Don’t worry. You didn’t know, and Lizzy’s got to get over this. I’ll see you at 5:30.” The line went dead, but I still held the receiver to my ear, feeling bad for Bill and his children.
Kim and Allie walked by me, wearing surgical caps and masks and with a sleeping Goliath in their arms. I held the operating room door open and flattened against the wall to get out of their way. They walked in unison, struggling with 100 pounds of dead weight. For some reason, animals seem to weigh more when they are anesthetized. I donned a cap and mask and helped them put Goliath on the surgery table.
“Dr. Nelson, we’ve got this under control. Go scrub,” Allie directed. Allie and Kim were always thinking two steps ahead to keep us on schedule. Unfortunately, in a veterinary clinic, something often happens to derail the plan. Maybe today would be different. I retreated to scrub, as ordered. Even though I was the doctor and owner, I wasn’t
really in charge.
An hour later, Allie and Kim reversed their earlier process and brought Goliath out after surgery. This time, he sported a bandage on his injured hip. Goliath rested on a bed of blankets in his run. Kim sat by his head. Her right hand rested on his chest; the left held the trach tube protruding from his mouth.
Allie ran back and forth between the operating room and the treatment room, preparing for our next surgery. Captain sat quietly in the run next door, barely able to keep his eyes open. Obviously, Kim’s pokey butt had worked.
I pulled a large box full of splints of all sizes from the storage area. I rummaged for two minutes before spotting a small plastic splint that would be perfect for Mari.
“Want to do Mari now, Dr. Nelson?” Kim asked. She tossed Goliath’s trach tube into the sink for cleaning. “He’s waking up great; doesn’t seem to be in pain.” She opened the door to Mari’s cage in the treatment room. Mari dove into Kim’s arms and showered her with kisses. “Aren’t you a friendly little girl?”
“The pain meds are helping her, too,” I said. “But she is very friendly.”
“Do you want her on the table or can I hold her for this?”
“I think she’ll be better in your arms. She likes to be held.”
Kim extended Mari’s injured leg by pushing on the elbow. I wrapped an entire roll of soft white cotton around her leg for padding, then covered the layer with stretch gauze. After every wrap, I pulled the gauze tight over the cotton to provide uniform pressure.
“Let’s see if I picked the right splint.” I smiled at Kim and held the dark green plastic splint against the bandage. The “J” shaped splint fit her perfectly. I smiled again and wrapped it into place with another round of gauze. I held up four different colors of Vetrap — yellow, pink, blue and green.
“Which one should I use for the final layer?”
“I’d use the hot pink. It goes nicely with her black and white fur,” Kim responded. “Maybe it will make the little girl feel better, too.” I nodded and applied the outer hot pink layer to the bandage.
“There you go, Mari.” I motioned for Kim to place her on the floor. The instant Mari’s feet touched the floor she stood on her back legs with both front legs resting on Kim’s leg. She waited for a minute for Kim to pick her up. When Kim refused, she hobbled over to me, holding her splint out in front of her.
“How could I possibly resist such a sweet face?” I asked, scooping her up. I inspected the splint one more time before returning her to her cage.
While Kim and Allie prepared Captain for his neuter, I checked on Snowflake. The big white cat slept peacefully in the incubator with an IV catheter taped into a vein on his front left leg. His X-rays revealed an empty stomach and an enlarged liver. Thankfully, I didn’t see any masses in his abdomen or chest.
I opened a small, round cover on the side of the incubator and reached my hand through the portal. When I touched Snowflake, he opened his eyes and meowed once. He felt warm to the touch now and his gums were moist, not sticky. I rubbed his chin a few times before withdrawing my hand. He closed his eyes and went back to sleep.
“How long ‘til the blood work is back on Snowflake?” I asked Allie, but she couldn’t hear me with the stethoscope in her ears.
“The driver is on his way over,” Kim said for Allie. “They promised we would have the results in an hour.”
“And his urine,” I continued.
“I’m going to run the urinalysis after I help Allie set Captain up in surgery. I’ve already spun the sample, so it shouldn’t take long.”
“Let me know ASAP. I’m really worried about him.”
Fifteen minutes later, Captain slept peacefully on the operating room table. Allie sat on a stool by his head with a clipboard in her hand, watching the monitors and recording his heart and respiratory rate. A blue paper drape covered the rest of his body. With a gloved hand, I picked up the scalpel to make the incision.
“OK, I’m starting,” I announced. Allie made a red “X” on the anesthesia timeline. As my hand moved through the surgical field, I thought about the first time I met Captain. He was a ball of black fluffy fur with beautiful white and rust accents on his face. Then I remembered that horrific day when Jennifer stood in the lobby with Captain in her arms, covered with his blood. I also recalled the weeks of bandage changes that followed.
“Dr. Nelson, I’ve got the urine results for you,” Kim said from the door. “Snowflake’s specific gravity is high at 1.052, and his bilirubin is off the charts.”
“No glucose?” I asked.
“No glucose,” she verified. “You can take diabetes off the rule-out list.” She then disappeared behind the door.
“Are you almost done?” Allie asked, adjusting the anesthetic machine.
“Almost.” Allie clicked the vaporizer dial to zero. Pure oxygen flowed down the tracheal tube into Captain’s lungs. He would be awake in minutes. I tied the last knot and trimmed the suture with a scissor. “Done!”
I removed the towel clamps, placed them on the Mayo stand with the other instruments and rolled the drape into a ball. Allie undid the ties on Captain’s legs. We rolled him onto his side and let him breathe oxygen for two more minutes. When his tongue started to move, Allie untied the gauze that held his trach tube in place. A minute later, the dog swallowed, and she pulled the tube out of his throat.
“Do you want help moving him?” Allie asked.
“No, I’ve got him,” I said. I threaded my arms under his body and pulled him off the table. “This is probably the last time I’ll be able to lift him.” I carried his limp body to the treatment room as Allie followed us, carrying his bag of fluids. I slowly lowered him onto a fresh bed of blankets on the floor.
Captain blinked under the bright lights. “Relax, Captain,” I told him. “Let the room stop spinning before you try to walk.” The pup exhaled loudly and went back to sleep. I grabbed the remaining half of my sandwich, a stack of medical records and sat down beside him.
“Taking a break, Dr. Nelson,” Kim observed with a giggle.
“I thought I would keep my favorite patient company as he wakes up.”
“Who are you trying to kid?” Allie interjected. “You love them all, even the ones with scales.” She shook her head and rolled her eyes. “I don’t get the fascination with reptiles, but whatever.”
“I feel sorry for them,” I said. “They get sick, and there aren’t many veterinarians to take care of them.” Before I could elaborate, the phone rang. Kim left to answer it in the pharmacy where it was much quieter.
“Hello, Minnesota Veterinary Center, Kim speaking.”
“Hello, hello,” Bongo mimicked her in a feminine voice. Kim held her finger to her mouth as she listened. Bongo flared her tail and spun around on her perch but thankfully remained silent.
“Bring her right in. We’ll be waiting.” Kim hung up the phone and returned to the treatment room. “Your break is over, Dr. Nelson. We have an emergency coming in.”
Allie and I froze, our eyes pinned on Kim’s face.
“Bianca Fleming was hit by a car,” Kim said. “She can’t move her back legs. I could hear her screaming in the background.” The three of us exchanged knowing glances. “They’ll be here in 10 minutes.”
Kim’s words unleashed a flurry of activity. Allie disinfected the treatment table and wiped it dry with a paper towel. I wheeled the Mayo stand from the OR and positioned it by the table. Medicine bottles, syringes, IV sets and fluids magically appeared. Kim loaded new films into the X-ray machine and double-checked the temperature on the processor. Captain rested on his bed of blankets, blissfully unaware of the commotion around him.
“Looks good,” Allie announced as she surveyed our work.
“Let’s hope we don’t need most of it,” Kim said as she headed up front to wait for Bianca.
I paced in front of the long light box used to read X-rays. Waiting was not my strong suit. Classmates in veterinary school teased me about being a �
�cut ’em and cure ’em” kind of gal. More surgeon mindset than internal medicine, I suppose.
The last time I saw Bianca she was in perfect health, full of energy. The spunky 2 year-old Shih Tzu had balanced on her back legs while begging for treats with her front. Tipping the scale at eight pounds, her body was no match for an automobile. I crossed my fingers and hoped the car did not damage her spinal cord. Bones can be fixed, but the spinal cord — not possible.
After what seemed an eternity but was only eight minutes, the doorbell rang. I could hear Bianca’s screams all the way back in the treatment room. Mark Flemming followed Kim through the clinic with the frightened dog in his arms. Mark’s wife Stephanie brought up the rear.
I helped Mark place Bianca on the table. I lifted her lip and applied pressure to her gum with my finger to check her capillary refill time (CRT). In healthy animals, the gum turns white for an instant when the blood is forced out and then reverts to pink in less than a second. Bianca’s gum stayed white. Next, I listened to her heart while feeling her leg for a pulse.
Lub, dub. Lub, dub. Her heart raced.
“She’s in shock. We need to start fluids right away.” I clipped a patch of hair from her front leg, sanitized the area and prepared to place the IV catheter. Her thin blue vein was half its normal size due to the shock. I popped the catheter through the skin and waited. Two seconds later, a drop of blood formed at the end of the catheter.
“Nice stick,” Allie said. I taped the catheter to Bianca’s leg, attached the drip line and opened the valve. Sterile Lactated Ringer’s poured into her vein. Now it was time to find out how much damage the car had done to her little body.
As always, I started my examination with the head. Her eyes, ears and mouth looked great, no bleeding anywhere. I let my hands slide down her neck and front legs. No problems. I listened to her chest again more carefully and noticed an area of dull lung sounds. Probably contusions from the accident, I thought. I placed the stethoscope back around my neck and turned my attention to the dog’s rear end. When I felt her abdomen, she swung her head around, teeth exposed.
Coated With Fur: A Blind Cat's Love Page 3