“You must stop beating yourself up for what you didn’t know,” I told her. “You made the best decision you could, based on the information you had. Now it’s time to let that go and celebrate Dolly’s good health.” I pointed at Dolly, who was licking the corner of the table. She froze with her tongue on the wood when she heard her name. “Follow Dolly’s example. She’s making up for lost time.” Jenna nodded while blinking back the tears.
“Dolly, come,” I commanded. She trotted to me, her tail wagging. “Sit.” Her rear end dropped to the ground. Her tail swept along the floor as she stared at the biscuit in my hand. I quickly lifted her left ear flap to expose the incision below. The T-shaped closure looked great with no gapping or signs of infection. A thick scab covered the exit hole for the drain. All of the swelling and pain were gone. “Good girl,” I praised her as I gave her the biscuit. She inhaled it and looked for more. When I didn’t move, she touched the pocket of my lab coat with her nose. I laughed and handed her another.
“What’s next, Dr. Nelson?” Jenna asked.
“Take her home and spoil her,” I replied while petting Dolly.
“I mean when does she need to come in again?” Jenna explained.
“She’s due for a heartworm test and vaccinations next spring. If you notice any change in her behavior before that, call me right away.”
“Thanks again, Dr. Nelson. I am so glad that you fixed our girl.”
“Just remember that the next time she chews something up,” I said with wink. We smiled at each other, then at Dolly. She responded as she always did by wagging her tail.
On the way out the door, Dolly crossed paths with Guacamole. Al sat in a lobby chair with the carrier on his lap wrapped in a thick blanket. When Dolly caught the unusual scent, she pulled Jenna back inside to investigate. Al stood up, holding the carrier high off the floor to keep Guacamole from Dolly. The black Lab sat below, sniffing the air.
“Sorry about that,” Jenna apologized to Al.
“No problem,” Al replied. “She’s probably never smelled an iguana before.” Jenna’s eyes dilated when she learned what was in the carrier. She immediately pulled Dolly away and hurried out the door. Ever since her brother scared her with a snake, she hated reptiles. She left without saying goodbye.
In the exam room, Al unwrapped the carrier for me. Guacamole rested inside on a faded purple washcloth. Her purple wrap looked brand new even though she’d been wearing it for more than a week.
“Does Guacamole like the color purple?” I asked Al.
He nodded, took a deep breath and launched into a story.
“One day I walked into the bathroom, with Little ‘G’ on my shoulder. My aunt gave me a set of purple towels for my birthday. Guacamole spotted a washcloth drying on a towel bar. She leapt off my shoulder, landing on the washcloth.” He laughed as he recounted the story. “I thought something spooked her, so I put her back on my shoulder, and she jumped off again. When I picked her up the second time, the washcloth came with. She held onto the corner with her mouth. A week later, she pulled the washcloth off the sink and dragged it into her cage.”
I pictured Guacamole trying to drag a washcloth that was twice the size of her body, tail not included, into her cage. This little lizard had a lot of personality.
“At first I thought she had a thing for washcloths,” Al continued. “Since that one was new, I gave her my old green one. She pushed it out through her cage bars.”
I cracked up.
“Finally, I realized it was the color,” Al concluded.
I stopped laughing when I remembered how Guacamole removed the first two bandages I placed on her.
“I never told you this, Al, but she had to train me, too.”
“Really.”
I nodded. “She ripped off the first two bandages I applied to her leg. The third time I used purple Vetrap with several chew tabs. She pulled off all the tabs but left the wrap alone.”
“Sorry, Dr. Nelson, I should have told you,” he apologized.
“Don’t sweat it. I’m going to make a note in her record so we know from now on: Everything has to be purple.” I wrote “purple” in all capital letters across the first page of her record and highlighted it in yellow. “Do you want to watch me change the wrap, or would you prefer to wait in the lobby?”
“If it’s all right with you, I’m going to make a phone call while you change it. I had to rearrange my schedule to get her in.”
Kim entered the room with her hands full of supplies. “Remember, Dr. Nelson, the food will be here in 10 minutes,” she said.
I nodded and began to cut the bandage material into Guacamole-sized strips. While I cut, Kim weighed the lizard on our bird scale. Although she gained 50 grams, we wouldn’t know the real number until we weighed the bandage.
I carefully peeled off the old bandage, layer by layer. Although I had a small bandage scissor in my lab coat, I didn’t want to injure Guacamole by shoving the blade between her body and the bandage. It would have been quicker, but her bones were too fragile to risk it. I placed each layer on the scale and subtracted the total. Guacamole gained 25 grams, about the same weight as a quarter.
In only four weeks of calcium supplements and better husbandry, her jaw looked less swollen and felt less rubbery to the touch. She also had more energy. The last time I wrapped her, she laid still for me. This time, she wiggled her legs and tail. The area between her wrist and elbow over the fractured bones was still swollen but seemed less painful to the iguana.
In less than five minutes, she sported a new, dry, purple wrap. When Kim put her back in her carrier, she rubbed her head on the washcloth. She reminded me of child with a baby blanket.
“Ding, ding,” the doorbell rang.
“That must be our lunch,” Kim beamed. Her stomach growled. “Do you want me to discharge Guacamole? Sometimes you get a little long-winded.”
“Long-winded,” I repeated. “Kim Larsen, you are Minnesota born and bred.” I smiled at her. “What happened to the nice part?”
“I’m just saying that you get chatty sometimes.”
“Who needs kids to point out personality flaws when you have techs?” I joked. We both started laughing. The sound of someone running on the squeaky lobby floor ended the fun. Allie opened the door and pointed at the lobby.
“Dr. Nelson, come quick. There’s a sick dog up front.” Allie spoke in rapid-fire blasts. “Her color looks bad. She shivering and can barely hold her head up.” I ran out the door with Allie. Kim put her hand on Guacamole’s carrier and sighed.
“So much for lunch,” she said. “So much for lunch.”
Chapter 17
Saint Francis
Minutes before, a small woman wearing a long black wool coat stood in the lobby, her black hair matching the coat perfectly. She held a long-haired Chihuahua in her arms. The chestnut-colored dog shivered uncontrollably.
“Can I help you?” Allie asked from behind the counter.
“This is Chica,” the woman answered. She spoke English with a Mexican accent. “She started vomiting last night. First food,” she paused to hug the little dog. “Now she can’t hold anything down. She’s so sick. Please help her.” Her eyes flooded with tears. “My husband is out of town. I didn’t know where to bring her.”
“You’ve come to the right place,” Allie said. “We will help her. Allie reached over the counter, lifted Chica’s lip and pressed her finger into the gum. Her gums and tongue were a muddy burgundy instead of a healthy pink. Her gums were dry, and it took three seconds for the color to return to the spot Allie pressed.
“She’s very sick,” Allie agreed. “I’m going to get Dr. Nelson right away.” She disappeared into the back. Thirty seconds later, we entered the lobby.
“Hi, I’m Dr. Nelson,” I said as I lifted Chica’s lip. Although the woman wore three-inch heels, I towered over her.
Kim brought Guacamole back to Al, disappointed to see a stranger in the lobby instead of the Olsons. Her smile tur
ned into a frown when she saw the sick dog.
“I’m Maria Sauer, and this is Chica,” the woman said. “My baby is so sick, and I don’t know what is wrong. She can’t stop vomiting.” Maria pronounced her ‘V’s more like a ‘B’. She reminded me of my days at the Animal Medical Center where many of my clients spoke English as a second language. One of their children typically played interpreter for me.
“Chica is extremely dehydrated,” I said. “She needs fluids right away.”
“What is wrong with her, Doctor?” Maria asked.
“I’m not sure yet.” I paused to think through the rule-outs for vomiting before continuing. “It could be a toxin, pancreatitis, kidney disease or even a foreign body.”
“I don’t understand?” Maria said. “What do you mean by foreign body?”
“She ate something like a bone or piece of plastic that is stuck in her stomach.”
“No, she never eats anything bad, Doctor. I take good care of her,” Maria said.
“Is she spayed?”
Maria nodded.
“Good, I can take an infected uterus off the list.” I smiled at Maria. “There are many, many causes of vomiting. She’ll need X-rays and lab work to determine the cause. But most importantly, she needs fluids right away.” I reached out to take Chica. “She’ll need to stay in the hospital until we know what’s causing this vomiting.”
Maria started to hand the dog to me but stopped when she heard my words.
“Stay in the hospital,” she repeated. “Are you sure? Chica does not like to be away from me.”
“She has to be in the hospital to get fluids.”
Maria ignored my comment, lost in thought about her precious companion. “Would you like to bring her in back to see where she’ll stay?” I offered.
“Yes, Doctor, I would like that very much.”
“Please follow me.”
On the way back to the treatment room, Maria noticed the birds. She paused for a moment to greet them in Spanish. Bongo whistled back, making Maria smile. When we reached the threshold to the treatment room, she stopped in the doorway. She scanned the room, starting with the bank of stainless steel cages next to the treatment table. Instead of a standard metal table with no storage, the treatment table was a peninsula cabinet with a blue laminate top. I bought it from a home improvement store by the clinic.
After viewing the surgical preparation area on the far side of the room, she walked inside for a better look at the footprints on the wall. Multi-colored stenciled footprints of dogs, cats and birds decorated the wall that housed the light box for viewing X-rays.
With Maria watching, Kim held Chica for her examination. The five-pound dog felt lousy. She allowed me to examine her without any drama, unusual for a Chihuahua. During my internship, we used to refer to this breed as land sharks because you never knew when they would strike. They could be licking your hand one moment and using it as a chew toy the next, still wagging their tails. Chica tolerated everything until my hands reached her abdomen. When I tried to palpate the area behind her ribs and under her spine, she screamed, teeth bared.
Maria rushed to soothe her.
“Es OK, bebe,” she whispered in Chica’s ear.
“Wow, she’s supper painful in the kidney area,” I noted. “She feels really warm to me. Let’s get a temp on her.” Kim held Chica with her rear end exposed and a tight grip on her head to prevent any problems. I inserted a digital thermometer. The numbers on the digital display started at 99.9 instead of “low.” I watched the numbers steadily creep higher, my concern growing with each point. When the instrument beeped, the display read 104.9.
“Chica has a high fever. If it gets much higher, I’m worried that she could have permanent damage. We need to start treating her right away.”
“What do you think is going on, Doctor?” Maria asked.
“I think she’s in septic shock, which means that she has an infection in her bloodstream. Based on my experience and her reaction, I’m guessing the infection started in the kidneys.”
“Can you save her?” Maria begged more than asked.
“With aggressive therapy, I’ve had pretty good luck with these cases. As long as her temperature doesn’t drop below normal, she has a chance.”
“Please get to work, Doctor. You must save Chica. You must!”
With Maria hovering, Allie set a pediatric catheter in Chica’s front leg while Kim held the dog. After she drew blood, I inserted a needle into Chica’s bladder for a urine sample. When I drew back the plunger, urine tinged with blood filled the syringe. I put half in a sterile tube for culture and left the other half in the syringe. Allie hurried off to the pharmacy/lab room with all of the samples in her hand. Thirty seconds later, the centrifuge whirred into action.
Shock of any kind is an emergency condition defined as a lack of circulation in the body. Shock is divided into three types: hypovolemic, cardiogenic and distributive. Hypovolemic means low volume and is used to describe shock primarily caused by blood or fluid loss. Poor heart function is the cause of cardiogenic shock. Septic shock fits into the distributive category, along with drug and allergic reactions. With septic shock, blood vessels dilate, decreasing blood flow throughout the body.
In the first phase of septic shock, the heart beats faster, blood pressure may increase slightly, and body temperature rises as the patient’s body tries to deal with the stagnated blood. This is called the hyperdynamic or warm phase. If the blood circulation is not restored, the patient deteriorates into the hypodynamic phase characterized by weak pulses, low body temperature and rapid, irregular respiration. I’ve never been able to save an animal that went into the cold phase.
Allie hurried into the treatment room with a piece of paper in her hand. “You were right, Dr. Nelson. I found lots of red blood cells, white blood cells and bacteria in her urine,” she announced. “Her blood glucose is low, too.”
The three keys to treating septic shock are fluids to support circulation, antibiotics to kill the bacteria, and sugar to supply the patient with the energy to fight off the infection. As long as her temperature stayed below 105, I would not do anything to decrease it. An increased body temperature slows the growth of bacteria and viruses and improves the body’s immune function.
I added dextrose to a bag of saline and gave her a bolus (dose) of fluids. After the bolus, I injected two different antibiotics into her catheter, one to fight gram-negative bacteria and one for gram-positive.
“Now we wait to see how Chica is going to respond,” I said after throwing the needles in the hard plastic sharps container. “I’ll call you as soon as I get the lab results.”
“Oh, I’m not leaving her here alone,” Maria declared. “I’m staying with her.” Maria stared at me with big brown eyes and folded her arms across her chest.
“I understand your concern, ma’am, but you can’t be back here during surgery,” I responded. “When we set up all the equipment, there isn’t enough room for visitors. It’s not safe.”
“Where will you put her if I go?” Maria asked.
“In the cage behind you where we can keep a close eye on her while she gets her fluids.” I pointed at the middle cage in the middle level of cages.
“No, Chica will not stay in a cage. I’m not leaving her,” Maria repeated. “That’s cruel.”
“We have to keep Chica from moving around, or she’ll rip out her IV line,” I explained in a quiet voice. “Also, dogs like to crawl into small protected spaces when they are ill. You think of this as a cage, but Chica will think of it as her private den.”
“No, she can sit in my lap for the fluids. I will hold her,” she countered.
“If you hold her, your body heat might push her temperature into the dangerous zone.” I paused to make sure she was listening. “In fact, I’ll bet it’s gone down already from being out of your arms.” Maria stood silently, gazing at Chica. While Kim held the dog, I took her temperature. The device beeped at 104.5 degrees.
“Visiting hours are from 9 to 11 a.m. and 3 to 5 p.m.,” I continued. “You are welcome to come back at 3 and stay with her until 5, but she cannot sit in your lap until her temperature breaks.”
“But what if something happens?” Maria pleaded. She made the sign of the cross, then kissed her fingertips. The color drained from her skin.
“I guess you could wait in the lobby,” I relented. Kim shot me an “Are you crazy look” when Maria wasn’t looking. Having people in the clinic made it more difficult to care for the animals. “But you can’t be back here again until 3 when visiting hours start.”
“Oh, thank you, Doctor,” Maria replied with a smile. I returned the smile, showing the dimples on both sides of my mouth. Maria kissed Chica on the forehead and reluctantly returned to the lobby.
While Kim settled Chica into her cage, I filled out her hospital orders. I wanted a temperature check every 30 minutes and her blood sugar every two hours.
Allie walked into the treatment room with a large picnic basket. The smell of freshly baked bread filled the air. The basket held crusty rolls, a spinach salad and brownies in addition to a pot of soup.
“Allie, is the 3 o’clock appointment slot still open?” I asked.
She nodded vigorously.
“Good, let’s have lunch while the food is warm, and we’ll start surgery in half an hour.”
Kim beamed with delight.
“Just remember to have the surgeries pick up 30 minutes later,” I added.
Allie unpacked the picnic basket on the counter in the pharmacy area. Allie and Kim sat on folding chairs next to the counter within easy reach of seconds. I invited Maria to have lunch with me in the treatment room where I could watch over Chica.
Maria told me she grew up in Mexico City with six brothers and sisters. She met her husband, Walter, while working in her family’s restaurant. He stopped by for a burrito on his way to work and left his card with a generous tip. They married a year later in the parish where she received her First Communion.
Coated With Fur: A Blind Cat's Love Page 18