Veterinary Tails

Senior Blood Work

2012-02-07T17:54:00.004-05:00

Often the most successful visits are the least exciting--the surgery that heals well, the diabetic who is easily managed, the limping that turns out to be just a broken nail. Unfortunately the opposite is true as well. It usually doesn't bode well when I have a "very interesting case", although there certainly are exceptions. Many of those exceptions appear in this blog, but today I have a sadder tale.

A 12 year old cat came in for a routine visit several weeks ago to have some lumps checked. These turned out to be mast cell tumors. Although these can be treated more conservatively in cats than in dogs, these tumors were in locations (mouth, eyelid) where they would be difficult to remove if they got larger. Before surgery we ran some senior blood work. This showed a mild elevation in the kidney values and a high red blood cell count. I was suspicious that the high red cells might just be a lab error or some dehydration, but the kidney elevation seemed a little out of place as well.

As most cat families know, chronic kidney insufficiency is common in older cats, but something just didn't seem to fit. The first step in working up this problem is to recheck the values to see if they are consistent. Well, today she came in for a recheck and possible surgery. Unfortunately, her kidney values were even higher and her RBCs remained elevated. I decided the best course was to look at her kidneys with ultrasound to see if there were just age related changes or a more significant problem. Both kidneys looked very abnormal and there was a large (half the diameter of the kidney) tumor in the left one.

Now the pieces fell into place--a kidney tumor that was not only contributing to the kidney dysfunction, but was probably stimulating the high RBCs. You see, the kidneys produce erythropoetin, a hormone that stimulates the bone marrow to produce erythrocytes (RBCs). In fact, some cats with chronic kidney disease are put on epogen (replacement hormone) because their kidneys don't produce enough! For this kitty, the tumor was probably overproducing this hormone.

Needless to say, we cancelled surgery and started supportive care (home fluid therapy) to keep the kidney values in line. Fortunately this condition is not causing any significant discomfort right now, but we suspect that we might see some more complications within the next 3-4 months.

This case is a reminder that some level of preanesthetic screening is a good idea in pets. It saved this kitty from undergoing a procedure that would not have provided the long term benefit that we intended. It also allowed us to intervene earlier in treating the kidney disease. This will certainly lead to a better quality of life, no matter how quickly her condition progresses.

Take a Chance on Me

2012-02-06T17:33:00.008-05:00

This is one of those stories that every animal lover hopes for:

A 3.6 pound hypothermic cat with chiggers, neurologic signs, crusty eyes, skin sores, and jaundice was rescued by one of our very compassionate clients from certain death in the outdoors. Finally ill enough to catch, this young stray cat was brought to us with a temperature that didn't even register on our digital thermometer. We were certain that tests would show some sort of major health problem, but blood work and x-rays only showed mild anemia and mild jaundice.

We set to work warming, hydrating and syringe feeding her. At first she seemed to respond well, but her weakness just wouldn't improve. We rechecked her blood work, concerned that the hydration had diluted her blood and found that her potassium was very low. This was treatable, but unfortunately her red cells and protein level were lower. Worse, a recheck 2 days later showed a critically low protein level.

She was eating better with some assistance however, and a vocal personality was starting to emerge, so we sent her home for continued TLC . She started eating without assistance and regained her strength. Still, I was afraid I'd have bad news when we rechecked her blood work today. To my surprise, her red cells and protein were improved and she was noticably stronger and more alert. She still has a long way to go, but seeing her sit contentedly in her new mom's lap was so sweet! And now she has a name: Chance.

I hope to follow up with more pictures documenting her recovery, but 6 days out, here she is:

Plant Awns

2012-01-28T11:39:00.002-05:00

Today a Golden Retriever presented with a rapidly growing mass under her jaw. It was not painful or inflamed, but when I took some fluid out of it with a needle, I saw very large numbers of bacteria and white blood cells. I suspected that this abscess could be due to a foreign body or infected salivary gland, so I sedated her and made an incision over the mass. After blotting away the fluid that came out of it, I was relieved to see this plant awn inside.

This 1 cm seed pod can penetrate tissue, and due to its shape, can't back out. Although plant awns are more common out west, we see our fair share of them here. In fact, I once saw 2 dogs, 2 days in a row, with plant awns lodged in the mucus membranes of their left eyes. And they were from the same family!

I believe this awn migrated from the mouth rather than through the skin for three reasons: First, the mucus membranes of the mouth are much thinner. Second, I could actually feel a thin tubular structure leading to the abscess. This was the tract that the awn followed before it was walled off by the body and led to the abscess. Finally, the type of bacteria in the abscess were typical of oral bacteria, and not the skin.

Along for the Journey

2011-11-15T17:33:00.003-05:00

Yesterday a man arrived on Towne's front doorstep with 2 dogs, a bike, and what I assume were most of his worldly possessions. He was on his way from New York to Daytona Beach to stay with a friend and was walking the bike and the dogs when he couldn't hitch a ride. The dogs looked healthy but tired, and faithfully stood by their master's side.

Today I was reflecting on his journey and thinking how much more bearable the rough days must be (and how much nicer the good ones) with those companions by his side. Despite our different circumstances, we can all relate to that!

The Upside of All The Rain

2011-09-13T20:49:00.006-04:00

After major rainfall, boaters like myself watch the Little Falls guage for the Potomac River. Normally at 2.5-3 feet during the dry summer, the river roars to life at 6 feet and a perfect surfing wave forms where Difficult Run flows into the river. 5-15 boaters wait in line in a narrow eddy to take turns carving up the wave. Even surfboards and stand up paddleboards were seen this past Sunday in perfect 80 degree sunny weather.

Easing your way up the eddy, you power across the eddy line into the current above the wave. A quick ferry across a minor standing wave moves you into position 15 yards above the target. You coast backward into the trough of the wave, then up the back until you are stopped by the breaking foam pile which, at lower levels, can turn into a sticky hole. Now though, it just stops your downstream momentum and you slide back up the wave face.

Now, although stationary relative to the shore, you are carvingback and forth across the water with thousands of cubic feet of river surging under and around you. Periodically the foam pile starts to break on your stern and you plunge deeper in to the oncoming water. Great Blue Herons fly over head. You dodge logs floating through the wave. You surf until the wave spits you out or you've had your fair time on it, then exit off the side and get in line to do it again.

Overall, an amazing way to spend a few hours on a Sunday afternoon!

What, is that Smell?

2011-08-12T09:12:00.003-04:00

I love mentoring because I usually learn as much as the mentored. Yesterday I was discussing a case with Dr. Berning, our new associate. My patient, an elderly cat had presented with decreased appetite and lethargy. With a history of hyperthyroidism, multiple missing teeth and several strokes that had resulted in hearing loss, there were many possible causes. In addition, through x-rays and ultrasound, we had discovered a large cyst in front of his heart.

We decided to tap the fluid off the cyst using ultrasound guidance, hoping that, if this was the main problem, we'd see immediate improvement. We also temporarily stopped the thyroid medication since long term use can result in toxicity in some cats. Dr. Berning suggested that another factor might be loss of sense of smell due to the strokes. This made sense since he seemed to prefer fish based foods. With this in mind, we recommended offering these foods, either alone or on top of the regular diet, warming the food, and continued use of an appetite stimulant. Thanks Dr, Berning!

(Interestingly, this patient was exposed to debris from 9-11. Living a mile downwind, he was outside when much of the debris permeated this neighborhood. I don't know that the cyst is related, but cysts are unusual enough that the link must be considered.)

Germs vs Man

2011-08-01T13:10:00.002-04:00

Another recent headline: Iodine, Alcohol Prep Pads in Kits Recalled. Guess why.
Bacterial Contamination! Add this to the list of food and pharmaceutical recalls that have taken place over the past several years due to chemical, bacterial, and particulate contamination. In today's mass manufacturing environment, it isn't suprising that these recalls occur, but bacterial contamination of antibacterial materials stands out. Imagine the fallout if a production lot of hand sanitizer became contaminated! This is yet another reason for common sense prevention-hand washing with regular soap and water, sterile technique in hospitals, and judicious use of antimicrobials.

Dog Bite Prevention

2011-08-01T12:43:00.002-04:00

A recent headline in one of our trade journals reads: "AVMA, Postal Service Join Effort to Prevent Dog Bites". Although this brings to mind an almost comical image of a mail carrier being nipped at by the family dog, anyone who has been bitten, myself included, knows this is no laughing matter.

Two stats from this article are worth noting. Medical expenses for the 5,669 postal employees that were bitten in 2010 amounted to $1.2 million. And one third of homeowners claims in 2010 were for dog bite related inuries, costing $413 million!

My two most memorable bites were early in my career. Actually the first was at a clinic where I was volunteering as a teenager. I was holding a large shepherd for an injection and he whipped around a grazed my shoulder. It didn't do much damage but seeing how easily my face could have been damaged gave me a healthy appreciation of adequate restraint and the ability to read body language.

The second was with a little terrier that I knew was a biter. She seemed relaxed so I carelessly reached into the cage and she bit me right through my fingernail. That little gift from her stayed with me for a good 3 months!

Biting is one of the most difficult behaviors to correct. Proper socialization and temperament testing can go a long way, so start early with your own pets and educate yourself and your children about approaching other dogs. More in this AVMA brochure.

How Doctors Think

2011-07-27T12:15:00.001-04:00

I ran across this book on the Fairfax County Library Audiobook site. Not only has it provided an interesting perspective on how human medical doctors think through cases, but it has provided plenty of material for self-examination. There are many cognitive errors that can compromise a diagnosis, from being satisfied with the first answer we have evidence for (search satisfaction) to letting our relationship with a client unduly affect our recommendations (affective error). Dr Groopman illustrates these with real life examples and follows up with questions that you can ask your doctor when you think something might be being overlooked, such as "What else could be causing these symptoms?" A worth while read for anyone who might have to navigate through the human (or veterinary) medical landscape, and that means most of us.

Mysteries of Life

2011-06-01T08:30:00.004-04:00

Recently, my wife and children rescued tadpoles from a tire rut filled with rainwater. This vernal habitat has long since dried up, but 40+ tadpoles are thriving in our home. One of them wasn't looking so well so we removed him(?) from the tank. This prompted us to observe him in a little glass saucer with the 20-4ox power microscope we had gotten for homeschooling years ago.

First we looked at his eyes. I called my wife, the kids, and their friends who were visiting and they all lined up to look through the eyepiece. After many "oohs" and "aahs", I focused on the tail. There, in the transparent part of the tail that surrounds the spinal column, one could see individual blood cells traveling out along arterioles to the tail margin, then back through venules to the main vessels. This poor tadpole obviously wasn't moving much at this point, but his circulatory system was well enough for us to get an excellent view of the wonders of creation.

These same amazingly complex microscopic processes are going on throughout our body 24 hours per day, every day for decades. Unfortunately, we seldom recognize the beauty of biology until something stops working correctly. Mysteries still far outweigh our knowledge when it comes to life, but ever since veterinary school I've felt priveleged to be in a profession that allows me to care for patients within the bounds of that knowledge. (Sometimes that means just not interfering with the body's ability to heal.)

Awww...I want one!

2011-05-26T11:58:00.002-04:00

I grew up with a beagle named, don't laugh, "Lassie". The family got her at "Puppy Palace" and on the way home my sister and I were asked to come up with a name. I didn't know any other dog names at that young age, so Lassie it was! She lived a long life and passed away when I was in college--I'm glad I didn't have to face that at the time. Now we have an odd looking but lovable mutt named Dusty, but there will always be a special place in my heart for beagles.

It's a Girl!

2011-05-07T13:06:00.003-04:00

Most Saturdays start off slowly and get busier throughout the morning. Today, however, we started off with an early emergency c-section on a young mom with one very large puppy. We were a little concerned because the meconium (fetal stool) was in the fetal sac, but this little girl did great and went home several hours later with a healthy start to life. Here she is:

Clinic Tour

2011-04-05T10:09:00.017-04:00

The Front Entrance off the main parking area.

As you can tell from the reflection, we are ADA compliant!

Reception DeskClient Lounge (with complimentary coffee and tea!)

Exam Room Pharmacy

Laboratory

ICU/Outpatient Treatment

Dentistry/Surgery Prep

Imaging (Radiography/Ultrasonography)

Surgery

Kennel

We'd be happy to give you a tour next time you are in!

School and scout groups are welcome as well.

Ribbon Cutting

2011-03-05T16:24:00.003-05:00

In a quiet ceremony today, we had our official ribbon cutting. Mayor Kristen Umstattd and other town and county representatives gathered with the families of Dr Bollenbeck and Rice, a few of our staff and friends (and Dusty) to recognize our move to the new facility. Having delayed the original ribbon cutting ceremony, we were pleased to mark this milestone in our business' growth. When the nicer weather arrives, we will have an open house during which we will celebrate again with our full staff and clients. Stay tuned!

No Superbowl

2011-03-05T16:15:00.004-05:00

One of our senior patients stopped eating suddenly. She would go up to the bowl but then not want to eat. We assumed her kidney values were up or her reflux had flared up, but blood work revealed no problems and there were no other GI symptoms. No evidence of dental issues or swallowing problems.....

This situation is common and a dilemma for us. Do we wait and see if our elderly patients are just having a few bad days and will get better on their own, or do we do additional tests and treatments which may or may not be helpful. Well, in this case, our client figured out the reason for the inappetance: a new shiny metal food bowl! Apparently, this kitty would see her distorted reflection everytime she went up the the bowl and was put off by it. A switch back to the old bowl solved the problem.

From now on, "new food dish?" is going to be on my list of historical questions!

Our New Home

2011-02-13T13:41:00.003-05:00

Well, we finally are in our new home! On Thursday, February 10, 2011, we moved from Market Street to Plaza Street and saw our first appointment Friday morning! Once we've unpacked more completely, we'll post some pictures, but we are up and running with few hiccups. The space is taking shape quickly and the work space is a welcome upgrade over our former facility. We look forward to seeing you and your pets soon. Stay tuned for our ribbon cutting and open house in early March.

Ely: "I thought you said tutored!"

2011-02-03T12:57:00.007-05:00

Here is a look behind the scenes of a surgical visit:

Ely arrives in the morning having skipped breakfast. Robin gets his weight sets him up in a comfortable cage with an ID collar. Ely wonders what neutering is.

His check-in sheet tells us that he needs some preanesthetic blood work to make sure he can safely be sedated.

During his exam, the doctor determines that several baby teeth have not come out. After consulting Ely's mom, a plan is made to remove them under anesthesia. A medication is given to control pain and smooth out the anesthesia.

When this has taken effect and the blood work has come back normal, Ely is sedated with an injection and then put on oxygen and anesthetic gas for the procedure. Fluids and antibiotics are administerd as well. All goes well with surgery and the extractions, but an examination of Ely's ears under sedation show a large wax plug over the right ear drum. A loop is used to carefully remove it and the ear drum is healthy underneath. Our technician implants a microchip for identification and Ely goes to the recovery area. Later that day, Ely goes home with some additional pain medication for the next 48 hours.

(Even with a "routine" surgery, there are always individual considerations, and in this case the dental and ear issues were able to be addressed without a second anesthetic procedure. We love our hi-tech tools (ultrasound, anesthetic monitors, digital dental x-ray, in-house lab, etc.) but the foundation of good care will always be the physical exam! )

Reunited

2011-02-03T09:10:00.003-05:00

Most folks have heard of microchipping their pet. A "microchip" is an inert rice sized bead that contains an electronic device that holds a code. When the chip is scanned, the scanner induces a signal in the chip that is transmitted to the scanner to reveal the code. If the code is registered with the microchip company, the owner's contact information can be used to contact them. Here's one story that I'll add to the mix of reunions facilitated by this technology:

A new client presented a wonderful cat that they had named Elvis for an exam. Elvis had been hanging out around their house and being fed by them for about 6 months when they decided to formally adopt him and get him caught up on his vaccines and deworming. We identified some significant dental issues that needed to be addressed and the client agreed to leave Elvis to have the dental procedures done.

Before I sedated Elvis, we scanned him and found a chip. I called the new client to let them know the news, knowing they would be disappointed if they couldn't keep Elvis. They graciously said that if Elvis was missing from a home, he could be returned, but they would love to keep him if the original family could not be found. Well, we did find his first family through the microchip company. Elvis had disappeared 6 months earlier and they were relieved to find that he had been taken care since then.

The original family did cat rescue work and had several other cats to care for, so Mrs. was willing to allow the new client to adopt Elvis, but she needed to check with her husband who had been very attached to Elvis. Fortunately, he also agreed to let the new client keep Elvis.

Even though a reunion ultimately did not take place, Elvis's former family has the peace of mind of knowing that he is in a good home. And Elvis had his dental work, is up to date on his routine preventive care, and is living happily in his new home!

Sign of the Times

2011-02-03T09:03:00.002-05:00

Our new sign was installed recently--now Plaza Street is really starting to feel like home! Our improvements to the handicap parking spaces should be complete within a week if the weather holds out and hopefully we'll be moved in by mid February. The excitement builds!

The Twilight Zone

2011-01-28T20:56:00.004-05:00

Great news:

Final building inspection: done!
Low voltage permit: done!
Sign: done!
Cat condo installation: done!
Phone installation and training: done!
Veterinary inspection: passed with flying colors!

Final zoning permit: delayed! Our goal of a February 1 opening date has been delayed until later in February due to some unforseen parking lot issues. This is a bump in the road, so to speak, of an otherwise smooth process, so we are taking this extra time to fine tune the transition. We'll update you as our move-in date gets closer.

Ahh, the best laid plans of mice and men...

We're Floored

2011-01-09T15:46:00.006-05:00

The floors are in and looking good. We chose tile for the reception/waiting area for a durable, attractive surface.

The clinical areas have industrial sheet vinyl with heat welded seams.

The epoxy kennel floor is tough, water proof, and easy to keep clean.

Final finishing touches are in progress. Next comes equipment and kennel installation along with a myriad of final inspections.

Veterinary Tiles

2011-01-02T15:00:00.002-05:00

Happy New Year! One month to go on our clinic buildout. We are at the flooring stage-last week the tile was laid and next week the vinyl will be going in. We are still aiming for a Feb 1 start date but will let you know when the date is finalized.

Ceiling, Door and Cabinet Tour

2010-12-25T11:52:00.009-05:00

As you walk in the front door, you face the reception desk (desk not installed yet)

To your right is the waiting area

The exam rooms are on the left. Not much to look at yet!

On the other side of the exam room, our pharmacy takes shape

On the way to the clinical area, you pass the doctor's office

As you enter the treatment room, the lab is on your left

The main treatment island has a dry (medical) side

and a wet (surgical prep and dental) side

The tile goes in next week, then the heavy duty sheet vinyl and poured epoxy kennel floor. We are still on schedule for a Feb 1 start date--more to come.

Beautiful Women

2010-12-25T11:33:00.003-05:00

We recently had our clinic Christmas celebration at Clydes in Ashburn. As I told the staff, the new clinic that we are building is only a tool for us to practice good medicine and surgery. It is our staff that makes Towne Animal Clinic what it is. We are so proud of the role they play in helping to care for our patients. As we have grown together as a practice and family, we value them more and more, not just for their clinical skills and knowledge, but for the dedication to their families, the challenges they have overcome, the beautiful people they are.

Uncomplicated

2010-12-24T11:39:00.003-05:00

The human-animal bond is truly a gift. One of the things that makes that relationship so special is how uncomplicated it is. When I come home, my dog is happy to see me. He doesn't remember that I didn't pay attention to him yesterday or that he didn't get that extra treat he wanted. When we play tug of war, he just wants to tug. No gloating at winning, no sadness at losing. He enjoys his food even though it is a nondescript nugget. He chases deer without thinking ahead to what he would do if he caught one. I can make his tail wag by just looking at him. A belly rub is as good as it gets. No complaints about not being able to sleep on the bed. No angst, no regrets, no worries about tomorrow.

I do wonder, however, what is behind that look of consternation as our new kitten eats from his food bowl!

Housebreaking 101

2010-12-22T17:42:00.002-05:00

A lot of time and text is devoted to housebreaking, but of all the techniques I've heard, this, I feel, is the most effective. I describe it here because it comes up so often in practice, perhaps more than any other behavioral issue.

1. During the training period, keep your dog on an approx 8-10 foot leash or in a crate at all times. The crate should be just big enought for him to turn around in. (If he urinates or defecates in his cage for more than a few days, has medical issues or cage anxiety, these are special cases and we should talk!) Do not paper train unless you can't let him out for more than about 8 hours (less for very young puppies). Paper training blurs the line of what is an appropriate bathroom area.

2. When outside the crate, even indoors, keep him on a the leash so that you can immediately correct any inappropriate behavior (including attempting to use the bathroom inside) with a sharp "NO", rattle can, etc. You must keep him under observation at all times so that each infraction is interrupted and corrected immediately.

3. When you take him outside to urinate, go to one spot in the yard and just stand there with him until he goes. You can say "Go Potty"or a similar phrase, but do not pet, feed, touch, or play with him. Once he goes, then reward him profusely with treats and play.

4. If he hasn't gone in 10 minutes or so, take him back inside and watch him closely, again keeping him on the leash or in his crate. Be prepared to take him outside again if he shows any signs of having to go.

5. If he has an accident and you don't catch him "in the act", clean it up but do not punish him.

6. After at least 2 weeks of no accidents, start letting him off the leash, but if accidents occur, return to the program described above.

There are many subtleties to housebreaking, but this covers 95% of dogs, young and old. Best of luck!

Paint, Cabinets and Lights

2010-12-18T16:46:00.005-05:00

While I was gone, a lot of progress was made on the new clinic. Walls were painted

Cabinets were installed

And light fixtures replaced the incandescent work lights.

Architectural Inspiration

2010-12-18T16:29:00.006-05:00

My wife and I just returned from Rome, Italy and Paros, Greece where we celebrated our 25th wedding anniversary and visited our daughter who is studying abroad. I'll give updates on the clinic progress in the next post, but the trip certainly put the scope of our project in perspective!

Pantheon

St John Lateran Basilica Doors

A Paros Sunset

Keep Your Eye on the Ball

2010-12-01T22:33:00.004-05:00

This is one of our favorites stories from several years ago:

Despite his lack of depth perception, “Bandito”, a 20 pound Jack Russel Terrier, was full of pep that June day when the yeast had finally won the battle over control of his ears. Little did we know as we sent him out the door, ear medication in paw, that a time bomb was ticking inside him, a vestige of maladies past and a vision of danger to come!

You see, Bandito’s poor vision was the result of an unfortunate shift in the location of his right lens and the resultant glaucoma that claimed his eye at the youthful age of 7. While his left eye was enjoying a mercifully low pressure, his right was a thing of the past, having been removed in its entirety. Seeking the most cosmetic outcome, his parents had elected to have the ophthalmologist place a rubber implant in the socket during surgery. In the following weeks, two separate implants failed. Both had been rejected shortly after surgery, and despite the ghastly looks from strange dogs on his daily walks (you know how cruel dogs can be) and the awkward moments in front of the mirror each morning, he had grown to accept his wink as a small price to pay for his suburban life and all the culinary perks that go with it.

One week after his ear visit, however, Bandito's world changed. Almost imperceptibly at first, he felt the shift. Up came the methazolamide, then up came the xalatan. Then gradually the waves of nausea crescendoed, leading to episodes of vomiting so numerous that within hours, his dedicated master had him looking at the wall of an exam room once again. Bandito considered biting Dr. Bollenbeck as he had seen the other terrier do in the room next door, but his gentle nature made him think better of it, resigning himself to a groan and menacing glance (to the left that is) as his abdomen was palpated.

The medication he was forced to swallow followed the same general route as the rest of his gastric contents that night, and the next day saw an even more dismal trip to the hospital. This time radiographs revealed a round foreign body in his intestinal tract. As he listened to the conversation between his master and Dr. Bollenbeck, he got the sinking feeling that he had been a very naughty dog. He then got very sleepy and recalled the room moving jerkily from left to right. Bandito’s next experience was expelling the endotracheal tube, a sensation that made vomiting feel like a good scratch behind the ears.

He happened to overhear the surgeon’s conversation with his master as he lay in recovery. He did not see the humor that Dr. Rice apparently did in having removed an eye prosthesis from his duodenum. After all, it had been over 2 months since Bandito had finally managed to scratch that darn thing out. Since it was too small to roll in, Bandito had followed the next prime directive regarding dogs and unsavory objects--he ate it. He recalled that it was smoother going down than most foreign bodies and had all but forgotten about its full-bodied, slightly woody flavor, but apparently it had not exited his stomach and started it's journey down the small intestine until yesterday.

He knew he was in the right home when his master graciously accepted the diagnosis and bore neither resentment nor scorn towards his entirely canine habits. And four months later, “blind in one eye and can't see out t'other”, he was confident that, should his left eye have to be removed, he certainly wouldn't be bothered or tempted by another prosthesis. Drs. Bollenbeck and Rice learned an important lesson as well--A dog's eyes aren't bigger than his stomach, but they are bigger than his small intestine!

The Gates of Trash

2010-12-01T08:25:00.003-05:00

There are little signs of progress all around the new clinic space, but the dumpster enclosure is the first completed structure. She's a beauty, especially with the sun majestically rising behind her!

There's a sink in my Office

2010-11-29T22:56:00.005-05:00

As we accumulate items for the new clinic, we must store them within the limited space of our existing faciliy. Everywhere I look I am reminded of a project to complete or solve: A sampling:

Cage parts

8' metal post

Sprayer hose

No Parking sign

Oxygen Manifold

Millwork Catalogs

Equipment catalogs

Site Plan Waiver Plat

48 inch walk in bathing tub

Wall mount fold down exam table

Recessed male DISS ceiling outlets

Scavenge Unit and 6 scavenger interfaces

Male DISS x 1/4 inch NPT Oxygen fitting

Quick Disconnect Dental Water Supply fitting

Although Dr Bollenbeck and I are enthused by and dedicated to this project, I think we both are spending more time with clients in the exam room lately to get recharged by what we really love-veterinary medicine!

Thanksgiving

2010-11-27T11:51:00.003-05:00

I have a lot to be thankful for, but the relationships I have at work are some of the great treasures:

First, our patients. I don't really need to explain the "human-animal bond" if you are reading this blog. But it is evidenced by the frequent focus of holiday gathering conversations on our pets. Just mention your cat or dog and see how many stories this prompts!

Second, our clients. The nature of our business tends to bring us compassionate individuals. The relationships we have with them are one of the most satisfying aspects of our profession. We realize we are not just treating pets--we are keeping the human-animal bond healthy too.

Third, our employees, our second family. One of the rewarding parts of owning a small business is being able to provide a livelihood for our employees. Their dedication to our business has given us the opportunity to focus on their needs as well as those of our patients. They laugh, cry, study, learn and trouble shoot with us. We enjoy the satisfaction that comes from a job well done.

Finally, Jason Bollenbeck. Jason is one of the closest and most trusted individuals in my life. He is a man of integrity and dedication to his profession and the community. He has selflessly supported my role as a husband and father and has helped make me a better person. I couldn't have been given a better friend to live the dream of owning and now building our own veterinary hospital.

Details

2010-11-20T12:01:00.007-05:00

Other than the delivery of countless sheets of drywall, this is the stage of the buildout where nothing seems to be happpening at first glance, but on closer inspection many infrastructure items are going into place:

Wall insulation

Wiring for the wall outlets

HVAC duct work

and lots of Plumbing!

My Little Princess

2010-11-16T08:07:00.002-05:00

This isn't a veterinary or building post, but a dad story. Sunday our youngest turned six and had a princess-tea party-castle pinata-castle cake party with a few of her friends. The highlight was a doll house present that she opened earlier in the day and matching accessories that her friends gave her as gifts at the party. Of course, she played with the house all day long, well into the evening and all the next day. Rebecca has quite a vocabulary so we are used to her "grown-up" phrases, but her comment to my wife last night ranks in the top ten. Reflecting on her new present she said:

"Mom, that dollhouse has completely changed my life!"

(I guess I could say the same of the new clinic buildout)

Looking Up

2010-11-12T07:51:00.005-05:00

Here is another view from the entrance of the new clinic. This structure will support the lights and ceiling over the reception area. As you turn to the right you can see the waiting area. Since the ceililng grid is in, the ceiling height walls are also going up. The exam rooms are on the left and seating will be on the right. One client bathroom door is visible on the far wall to the left. Insulation partially hides the door to the store room. It is becoming more difficult to keep up with the pace of building, but we are happy to have that challenge!

Purrposeful Living

2010-11-09T14:50:00.002-05:00

Yesterday I was examining a cat who was very much at peace with the world. This kitty was purring the entire visit! As I checked his ears and eyes, joints, lymph nodes, teeth and abdomen, he just kept on purring. I had to listen to his heart for twice as long as usual just to make out the heart sounds under the vibration. The more I examined, the more he purred.

Amused by how happy this cat was, I remarked to the client, "Don't you wish we could be that content all the time?"

Later on I was thinking about that visit and how the responsibilities of our lives do sometimes distract us from the simple pleasures that add beauty to our lives--fall leaves, a brisk fall morning, the great sunsets of this past week, and the relationships with people around us. I realize that in today's world we need to be on our guard, but hopefully our pets remind us that it is wise to purr once in a while. Enjoy relationships with our fellow human beings. Look for the good in others. Get excited just to go on a W-A-L-K.

Perspective

2010-11-05T19:07:00.006-04:00

Construction is moving at an amazing pace. All the pre-planning is paying off as we see our dream become reality with relatively few "change orders" and surprises. Recently the floors were laid out. Although the marks on the concrete are the same as the ones on the drawings, some of the rooms looked alot smaller to us once they were laid out.

Once the walls started to go up things sure looked different. The rooms regained their dimensions and looked "normal " again. These are the full height walls that separate the sections of the clinic for sound and ventilation control. Later the dropped ceiling height walls will go in.

The walls now have one side with drywall until the electric and plumbing is in place. These views are all from the front entrance.

Post Blog Post

2010-10-31T21:17:00.002-04:00

We have to enclose our dumpsters as part of our zoning approval. This past week, the posts for the enclosure were installed. I was picturing 4x4 pressure treated posts and was concerned about how sturdy they would be. But what we got were HEAVY DUTY metal posts that will probably still be standing in 200 years. As long as they can take trash truck abuse! Next up:fencing.

The Three Birds of the Thorax

2010-10-22T08:20:00.008-04:00

One of my veterinary professors who taught cardiology had this corny but memorable joke:

Q: What are the three birds of the thorax?

A: The vagoose, the esophagoose and the thoracic duck! (a play on vagus, esophagus and thoracic duct)

Anyway, that's my segway into the state of construction. Here is the current view from the entrance (I'll try to be consistent with this view so you can see the progress from the "front door".)

Piles of dirt, drain pipes, pieces of duct work and construction equipment cover the floor as Bad Company pours over the boom box in the corner. The electrician arrived while I was taking these pictures. Soon they will run their lines and the concrete pourers will fill in the cuts to the floor.

Some of the ducts are already in place in preparation for the new HVAC unit.

This final picture shows the floor cut for the trench drain that will be in front of the dog runs in the kennel. We can't wait to give our first tour!

Concrete Cuts

2010-10-19T08:58:00.006-04:00

The past several days have seen additional demolition and the cutting of the concrete slab to allow the plumbers to lay new drains. Some of the cuts are just through the slab, but most involve 4-5 foot trenches to get to the main building drain pipes. Yesterday the space was a huge cloud of dust as the concrete saws, jackhammers and heavy equipment broke up the slab. This morning a sole worker stood chest deep in a hole digging the final foot of dirt around the main drain.

Meanwhile central vacuum and anesthetic scavenging (removing waste gas from the building) parts and pendant lights are starting to fill up our office as we stockpile supplies for later stages of construction.

After months of drawings, it is exciting to see real physical changes taking place!

In Memory of Lexy

2010-10-15T19:55:00.005-04:00

This is Lexy. Fifteen years old and all of 3.4 pounds, she is a beloved pet of one of our long time clients. We didn't know her when she was a youngster, but she has been a patient here for 5 years and over that time has surprised us with her resilience. Her most recent illness involved a bad kidney infection that almost took her life. Although she appeared quite fragile and was guarded at best in her prognosis, she rallied and recovered. And while even a younger, stronger dog would have needed intensive care for several days to pull through, she did so through the loving comfort of her "mom's" arms and outpatient visits at Towne.

Every visit brought more encouragement as her kidney values came down and her health improved. Yesterday her values were almost normal, she had gained back her weight, and her mom and I talked about long term followup. We said "see you in a month" and both went about our days, mine at church with my son's boy's club, and her at her daughter's Girl Scout meeting.

At home Lexy walked up stairs, curled up in her bed, and peacefully left this life. I'd like to think that she had conquered her illness and was ready to leave on her own terms. Perhaps we should just be thankful for the gentleness that characterized the substance and end of her life.

Demolition Derby

2010-10-13T15:23:00.004-04:00

Demolition of the new clinic space began today. As you can see, the walls are coming down and the ceiling tiles have been removed.

Althought this is a dirty job, you've got to admit that this worker has found a good way to relieve construction headaches:
Next up: Concrete cuts for the plumbing!

This is why I haven't blogged since February

2010-10-08T17:40:00.008-04:00

Earlier this year, Dr. Bollenbeck and I finally found a permanent home for Towne Animal Clinic. Although our current space at 338 E Market has served us well, "this old bank" is not the ideal clinic setting. We're also outgrowing the facility and needed to make a decision before our lease came up for renewal. So we've purchased 64 Plaza Street and are about to begin demolition next week!

Getting to this point has involved many hours of study, planning, and debate, quite a few meetings with the Town of Leesburg, and making hundreds of decisions from "Do we move?" to "What style of pendant light?", but we are very excited to finally be breaking ground. It will take about 4 months to complete the project with a tentative move in date of February 1, 2011.

The new clinic is directly across from the new Town Fire and Safety Station, very close to our current location. Upgrades to our current space will include:

Indoor dog runs
Handicap Accessible Entrance
Mens and Womens Bathrooms off the lobby!
Dedicated imaging center for X-ray and Ultrasound
Two Table Surgery Suite
Four Exam Rooms
A Break Room for our Staff
Cat Condos

I'll try to post regular photos of the construction as the various stages are completed. Here are some pre-demo pictures.

Dusty and Me

2010-02-10T09:11:00.003-05:00

My wife, our older kids and I just watched "Marley and Me" and, like any one who is owned by a dog, found Marley's antics humorous and somewhat familiar. Dusty is much better behaved but still has provided some memorable moments--helping himself to cookies off the kitchen table, bounding through the woods behind our house in pursuit of deer, bouncing at the front door as his master arrives at home. He is a young dog, so some of the more tearful moments of the movie are a long way off, but I try to remind myself frequently to "live in the moment" and appreciate that connection with Dusty now. Of course, dogs are excellent at living in the moment! No anxiety about tomorrow, no regrets about yesterday. Just seeking a masters touch with a gentle but persistent nudge. Well, what do you know, here he comes. Gotta go!.

A Difficult Call

2009-11-18T17:47:00.003-05:00

Dr Bollenbeck found a mass growing inside this dog's eye (the pink circular mass in the center of the picture). This 10 year old is a great companion and belongs to one of our best clients. The location of the mass was a little unusual but the appearance strongly suggested cancer. After an extensive search to make sure that there were no other tumors elsewhere, a decision had to be made about surgery. Should the tumor be removed (which means removing the eye), or should we watch the mass to see if it grows? Fearing that further growth might cause it to spread outside the eye, the decision was made to remove it. Good thing we did, as the biopsy revealed a carcinoma. A difficult decision but the right one for this dog's long term health.

This case highlights a unique aspect of veterinary medicine. Our patients experience little psychological stress from the loss of eyes, ears, limbs, teeth, testicles or ovaries. As dog and cat lovers, we are often affected more by the resulting change than they are. Pets, if they are pain-free and can function socially within the family, live pretty contentedly regardless of their appearance. Just look how happy Pugs are!

OUCH!

2009-11-18T17:35:00.002-05:00

Believe it or not, these are just some of the bladder stones from one dog. I've only seen 2 dogs in 20 years of practice with this particular type of stone. Most stones are made of calcium-oxalate, magnesium-ammonium-phosphate or urate. These unique stones are silica and have a "jackstone" appearance. Noone knows why some dogs get them. This patient had several lodged in his urethra and was quite painful. Fortunately, I was able to use a technique called urethrohydropulsion to flush them back into the bladder where they were easily removed. Without this technique, they have to be removed by an incision into the urethra with a resulting painful, complicated recovery. Few men wouild have trouble sympathizing with this dog, but the good news is that he was feeling great within a few days!

FANG-FANG

2009-11-18T17:15:00.006-05:00

One of the reasons to wait until 6 months to spay or neuter a dog or cat is shown above. The upper canine tooth (fang) has come in, but the baby fang behind it never fell out. This is an extremely common problem, especially in toy breed dogs, and will be apparent by 6 months of age. This is when most dogs would have had the permanent canine teeth erupt. While pets are under anesthesia, the baby teeth can be extracted, eliminating the crowding of the teeth. This is a delicate procedure since the baby teeth enamel is very thin, but one that pets recover from very quickly. Neutering or spaying can be done as early as 12 weeks of age, but if retained baby teeth have to be removed later, there is the additional cost of a second anesthetic procedure. Worse, pet owners may not notice the retained teeth, and the problem may not be addressed until the next exam. By that time, damage to the teeth and gums may have occurred.

The orange tube delivers oxygen (see the nice pink gums!) and anesthetic and allows us to "breathe" for our patient as need. The rubber bands help to gently hold the tube in place while being easily repositioned during the extraction. A nerve block has been done (hidden by the upper lip) to minimize any discomfort from the extraction.

So that's a lipoma!

2009-11-18T17:06:00.002-05:00

Many who have had a dog with a few extra pounds around the waist have seen lipomas develop under the skin. These are benign, slow growing tumors. Ususally we recommend leaving them alone, but occasionally we'll remove lipomas that are in awkward locations like the axilla (armpit). Frequently, these lipomas are encapsulated and come out in one large "glob". This is an example of such a lipoma. It was fist size and probably weighed 2 pounds. It is surprising how little blood supply there is to these tumors. In fact, the major surgical challenge is eliminating all the space that the lipoma took up so that the space doesn't fill up with fluid after surgery. There is no liposuction done in dogs, but this comes close!

Microsurgery

2009-11-18T16:56:00.003-05:00

This was a satisfying surgery on a rat with an ear tumor. Fortunately, the mass was attached to the margin of the ear, so I was able to remove part of the ear without having to compromise the canal or any major blood vessels or nerves. The black device is a mask that delivers the anesthetic gas. A little lidocaine cream on the surgery site kept this rat from scratching at the ear when it woke up. Total time: 10 minutes! (The length of anesthesia is critical--small critters cool off and can get dehydrated pretty quickly.)

What's in the box?

2009-07-31T13:40:00.002-04:00

Today is one of those days that reminds my staff and me that our role in the end of life issues is just as important as all the preventive care and treatment we do. In addition to our regular appointments, we have 2 euthanasias scheduled and 2 clients who had to bring in pets that had passed away at home after long illnesses. So far they have all elected to have their pets cremated privately and the ashes returned to them.

About half our clients choose this option, as opposed to a group cremation and burial. In less than a week, they will receive a small wooden box. What's in the box?

Stopping by the shelter "just to look".
Having said yes to having this pet in their lives.
The joys and challenges of puppy- and kitten-hood.
An interior re-decorator.
A mood lifter.
Enthusiastic tail wagging or purring.
Encouragement to take a walk.

A "child" who didn't grow up and go off to college.

Years of companionship.
Unconditional love.
A nonjudgmental friend.
A part of themselves.

...and ashes.

A Day in the Life

2009-04-27T19:48:00.002-04:00

6am-- Awaken, shower, dress, eat
7am--Leave to drop off boys at their carpool for school
7:15-7:45--Listen to book on tape (currently Red Mars)
7:45--Morning period of meditation in car before going into work
8am-noon--

Vomiting dog emergency and hospitalization, x-rays, ultrasound
Call about dental scaler repair
Two very friendly pit bulls for vaccine visit
Call Saturday's client about thyroid levels and plan for additional diagnostics
Second cup of coffee--only 2 sips
New (extremely cute) Puppy Visit
Dog Puncture wounds from other dogs attacks

Noon--Enter Quickbooks entries from Saturday.

12:30-2--Lunch meeting with Dr Bollenbeck

2:30--Cat ear injury surgery, Finally get to put on tie and doctors jacket!

3-7pm

Cat paw injury and x-rays
Tremoring older dog exam
Neurologic exam on middle aged dog
Ear recheck-resolved!
Dental recheck-resolved!
Senior exam and Mast Cell Tumor treatment plan
Fill out scaler loaner paperwork and have techs ship out scaler for repair
Type up Vaccine policy changes for staff meeting
Approve amlodipine dispense

8pm-type up blog

8:15-8:45 More book on tape

8:45-Spouse and kid time

I love this life.

Creatures Small

2009-03-09T20:11:00.002-04:00

This little hamster presented for a toe injury which the family attributed to a poorly designed exercise wheel. You can see that the tip of the toe is dead and part of it is only hanging on by a thread.

A quick snip and some surgical glue and the wound was closed. Not very high tech, but simple and effective. Satisfying too, as we are often limited in what we can do for these smallest of creatures.

Now to prepare for our 90 pound lab cruciate repair!

Tools of the Trade

2009-02-18T17:37:00.005-05:00

A 14 week old boxer puppy presented with 2 weeks of right rear leg pain. He was partial weight bearing, worse after exercise and had mild but definite swelling on the back of his hock (ankle). This area was painful, although I could flex and extend his hock with minimal complaint.

If you look above the text on the radiograph, you can see a slightly irregular outline to the bone as well as a dark area within the bone. Unsure as to whether this was definitely a bone infection, I posted this radiograph on VIN (Veterinary Information Network), an online forum of practitioners and specialists. Within hours, an orthopedic specialist got back to me with a confirmation of infection and recommendations on antibiotic therapy. Within days, this puppy was doing great!

The point of this story is that modern technological tools can augment clinical skills in a way that benefits patient, client and clinician. Without a thorough history and exam, I might have attributed the lameness to strain, sprain or a developmental disorder. Without good quality radiography, I could have easily missed the abnormal bone changes. And without the experienced eyes of a specialist, treatment would have been delayed. In this case the client benefited from an efficient (and less expensive) workup and early diagnosis and our puppy was able to enjoy being a puppy again!

Those who ignore history...

2009-02-12T21:41:00.003-05:00

I recently was reminded of the importance of a good history in the diagnostic workup. A hamster presented with a recent eye injury. Now I approach "pocket pets" just like dogs and cats: thorough husbandry, diet, and health history questions, a complete physical, a list of possible diagnoses and the tests necessary to confirm the problem before treatment. True, the nature of pocket pets often limits the amount that we are able to do, but I like to give them at least the benefit of a good history and physical.

Well this little hamster's eye had been proptosed (bulging out of the socket and lids) for at least a day and all my historical questions left the cause uncovered--no change in the cage environment, no previous eye rubbing, no irritants in the house, and no history of known trauma. It wasn't until I asked if there was any interaction with the family dog that I was told that the hamster had been found in the dog's water bowl 2 days earlier!

This answered the trauma question. And fortunately for this hamster, I was able to sedate it, clean and place the eye back in place and, using our smallest suture, suture the eyelids together to keep it in place while the swelling resolved. One week later we took the sutures out and to my pleasant surprise, the eye appeared normal!

That reminds me of another great eye story, but that's a tale for another day.

My First Real Emergency

2009-02-10T12:03:00.001-05:00

"The definition of an emergency is when you don't have time to refer to your emergency manual." This piece of wisdom was handed on to me the day before a very distressed Yorkie presented to the Cornell Veterinary Emergency Service. I was the on-duty doctor, and being only two months into my internship, the adrenaline provided unusual focus on "the ABC's of emergency care" (Airway, Breathing, Circulation). Based on the the blue gums and the lack of air movement despite violent gasping, I was able to stop at "A" and quickly came to the realization that I would be performing my first tracheotomy.

Hands shaking, I quickly gave some sedation, incised the roughly clipped skin on the neck, and made the stab incision into the trachea. A rush of air, several breaths, and the gums were turning pink again! 15 minutes later we had a very happy Yorkie and client.

It turns out that this pup had gotten ahold of a snake skin, part of which he had aspirated. During the tracheostomy it was dislodged (and swallowed!) After a night in the ICU for observation, the Yorkie was sent home and a healed beautifully. Several days later I received a thank you card from the client with Snoopy on the front. I forget what the card said, but the owner had drawn a little hole over Snoopy's trachea and written "ahhhhh". I still smile thinking about it. LR

Why I became a Veterinarian

2009-02-10T09:09:00.000-05:00

As I was growing up, James Herriott's stories of the life of a British veterinary surgeon provided romantic inspiration for becoming a veterinarian. The mentorship of Robert Brown, a softspoken and wise veterinarian further fanned that flame. My chemistry experience at Va Tech almost diverted my attentions to a laboratory career, but I stayed the course. Research hadn't lost its appeal however, and as I progressed through veterinary school, I became focused on laboratory animal medicine.

Then I went through my internal medicine rotation with Dr. Michael Leib, and everything changed. I was hooked on clinical medicine, companion animals, and clients. Clinical medicine allowed me to combine my academic interests with hands-on skills. I greatly enjoy the physical aspect of procedures such as surgery, endoscopy, and ultrasonography and the intellectual challenges of case management. Being able to do all this while working with dogs, cats, and other animals was particularly satisfying. And getting to know people as clients instead of patients fosters a type of relationship that is personal, and at the same time more objective.

There were some hurdles on the way to this profession: an early allergy to cats and an initial sqeamishness in the presence of blood (I still don't like needles in me!). But since 1988, I've only had two or three days that I didn't look forward to going into work. And all those romantic notions of treating animals from reading All Creatures Great and Small: They're Real!
I hope to share some of them in this blog.

Len Rice, DVM