Taking the plunge
3/24/2008 - The new list of houses for sale arrived in my inbox sometime over the weekend. I perused the list with little interest, focusing instead on the house for which we already had a bid entered. My husband, however, saw something in one of the listings that sparked his interest. It was essentially across the street from the very first house, the one we missed out on while I was in Kansas. Despite having a tight schedule, with my work day ending around four o?clock in the afternoon and his work day starting at six in the evening, he wanted to arrange a showing, if possible. I hurriedly sent an e-mail to the client/realtor, and awaited her response.
At the hospital, I would soon find that there was an even greater challenge awaiting me than being patient for a house. My technician arrived with one of her dogs, a six year old neutered male Pug very creatively named Pugsley Foo (aka Punky). He was not acting right, vomiting twice over the weekend, and showing no interest in his food. By the time he arrived at the hospital, though, he was acting somewhat normally, wiggling his posterior and curling his tail up like any Pug. His physical exam was essentially normal, other than his weight. Despite that she is in the veterinary field, her dogs have a tendency to have higher than ideal body-condition scores. To be on the safe side, though, we took abdominal radiographs and sent a full chemistry panel, CBC and urinalysis to to the diagnostic lab.
By the end of the working day, there was still not a phone call on the house bid, but there had been two phone calls from the client/realtor confirming our 4:30 appointment at the house my husband thought looked promising. I left the hospital only a few minutes after four, and sped away back to Lititz. In trying to arrive at the appointed house faster, I took what I thought was a short-cut, but realized that I do not have my husband's skills. He simply does not get lost, and we have always attributed that, jokingly, to his "internal GPS." I finally got turned around and found the house, walking in to find my husband on the deck with the seller and our client/realtor. I was perplexed by the seller being in the house, but later found out that the showing was canceled, but the message did not get to our client/realtor in time.
I felt as if we had a hurried showing, partly because of the inherent time crunch with our schedules and partly because the seller was on our heels, or so it seemed. But in the end, standing in the driveway, my husband and I agreed, we should put a bid in on this house. After all, it had nearly a half acre of land, something my husband absolutely loved, as he could envision throwing a baseball with a future son or daughter of ours. I loved the kitchen, with its ceramic tile, and the walk-out basement. Of course, I had visions of a large breed dog in the large back yard too! While it wasn't the "milk-and-honey" house, it was a house that we could see ourselves making a home.
I kissed my husband quickly in the driveway of what might be our new home, and watched him pull away in his Jeep, destined for work. I stayed for a few extra minutes, and talked to the client/realtor in the driveway. We set up time and place to meet and sign the bid paperwork the next day, knowing that if this bid was accepted, we would have to withdraw our bid on the other house. The cold air bit through my coat, and I was almost sure the seller was spying from an upstairs window, wondering what the conversation between myself and the client/realtor entailed. I was never more grateful to get home, and wrap myself from head to toe in a blanket.
I had not been home long enough yet for our cats to find me and curl up with me when my cell phone rang. As always, I checked the caller ID to see that it was a local number, but not one that I recognized. When I answered, it was my technician's housemate, who asked if I could check Pugsley's blood work online; at home, he had vomited again, and both my technician and her house mate were worried. I searched my e-mail, looking for the username and password, and thanking Google's Gmail for having enough space not to delete very old emails.
When I logged in and found the blood work, my eyes did a double take. The values in red caught my eye immediately, and all I initially said through the phone was, "Meet me at the hospital in 30 minutes." After explaining that Pugsley's liver values were some of the highest I had seen since veterinary school, including an ALT over 2,000 U/dL, an ALKP over 1,500 U/dL, and a bilirubin of 5.9, she understood that it was essential to hospitalize her friend and my technician's dog. This definitely was not just simple gastritis.
By 8:30 that evening, the IV catheter had been started, and his first doses of IV antibiotics, famotidine and ondansetron were administered. My technician's friend had drawn more blood for a coagulation profile and leptospirosis titers. Tears were freely flowing from my technician's eyes. I attempted to comfort her, reassuring her that Pugsley needed to be here, and that I would do all that I could to "fix' him. Although I did not show it, I needed the reassurance that I could fix him. In discussing the case with our board-certified surgeon, she suggested that perhaps it was a biliary mucocele, and in that case, truly I could not "fix" him, but he would become her patient for the surgery. An ultrasound was scheduled for the next morning.
The night was fitful for me, as I found myself unable to wind down and relax. My thoughts bounced back and forth between Pugsley and the impending bid on the house. In this case, we would have an answer in 24 hours, meaning we were potentially 48 hours from being homeowners. Pugsley was in the hospital, a very sick little dog, and I was not sure what would be found the next day, and if what we found could be reversed. Mark was at work that night, and so my frustration and sleeplessness went unchecked. There was nothing he could do to soothe my mind tonight, except send me text messages telling me to fall asleep. That was easier said than done. The hours ticked by: one, two, three, four in the morning. I finally fell asleep sometime after four; but sleep was short-lived as the alarm rang at 20 before six.
In the morning, when I examined Pugsley, I was dismayed to see that overnight, his sclera, pinna and mucous membranes had started to show a yellow tinge. My technician knew that this was not a good finding, and tried to stay strong. The human-animal bond was clear, though, and she found that she could not stop her mind from worrying, and could not stop crying in sadness and frustration for the uncertainty that surrounded her pet. Before seeing my morning appointments, I downed the first of two energy drinks. I sipped, or gulped depending on the perspective, and wrote up treatments for the day for Pugsley. I requested a bile acids test to be sent out before the ultrasound, in addition to the lab work from the previous day. Thinking that if this was a case of leptospirosis, doxycycline would help, I desperately wanted to get that drug into him. At the same time, though, everything that went in him seemed to come right back up, including the small amount of food given to him for the bile-acids test. It felt like a catch-22; our hospital did not have the injectable version of doxycycline, and I was given little hope that we could obtain any of the drug quickly.
The morning passed by quickly, and I found some sunshine in my day as I examined 14 English bulldog pups. The one with the dark spot on her head received extra cuddling from me at the end of the exam. Although it's not a breed that I would typically say I am attracted to, there was some sort of aura about these pups that was absolutely gravitational. After the pups were on their way, I hurried back to ultrasound to catch the end of Pugsley's exam.
I walked into the darkened room to see the flashes of black and white created by the sound waves on the monitor. The board-certified radiologist found nothing abnormal on the ultrasound exam. The finding was great for Pugsley, in that there was not a surgical lesion, but for me, it meant that I was still stuck with an open diagnosis in a vomiting, jaundiced and still very sick dog. I revealed the news to my technician, who promptly spent the next hour cuddling with her dog in his kennel. As much as I did not want to leave at that moment, I grabbed my coat and scarf, and trekked across the wet, sometimes icy, parking lot to the Smoketown Diner.
Awaiting me there was my husband and the client/realtor. I sat down and was presented with a stack of papers, already signed by my husband, now requiring my initials on multiple pages and my signature at the end. In less than two minutes, it was signed and in the hands of our client/realtor, who left quickly, spiriting away the document that could change our lives. My husband and I ate lunch, and I felt the need for a nap enveloping my consciousness. He encouraged me not to nap now, telling me it would be harder to fall asleep later. After lunch, I kissed him good-bye, and walked back across the parking lot to the hospital, where I would have seven-and-a-half more hours to go before I could fall asleep.
Arriving back at the hospital, a colleague suggested that I add in metoclopramide to the growing list of medications that Pugsley was scheduled to receive. Taking that one step further, I thought I would start a CRI, instead of doses separated by several hours. It seemed like a great idea. Then, I remembered that I'm not a mathematician, but a veterinarian, and found myself frustrated by the calculations. Eventually, a colleague and I figured it out, although in a slightly round-about way than following the formula in Nelson and Couto's Small Animal Internal Medicine. (During the writing of this, I found some amazing calculators online. I wish I would have thought to Google the topic when I was scribbling out multiple calculations by hand on scrap paper! Thanks to Dr. Brandt at UC-Davis!)
Unfortunately, the metoclopramide did not seem to help as much as I had hoped it would through the remainder of the day. Although Pugsley's chart and cage card were clearly marked "NPO," he was still vomiting, although not quite as frequently. When I left the hospital that night, I was still very concerned for his hour-by-hour status, but couldn't help but falling straight asleep on the couch as soon as I got home. After the guys were done crooning on American Idol that evening, my husband coaxed me upstairs to bed, of which I don't remember, and I slept soundly through the night.