Seven Days a Week

There are some things that you know so well and have done for so long that you just take it for granted that other people know it, too.  It’s a bit of reality check when you find out just how wrong you are.

I’ve been seeing Pepper since she was a little puppy.  She’s ten years old now, and we’ve seen her through repeated problems with bladder stones, finally finding a program of dietary management and monitoring that has eliminated the need for repeated surgeries. She’s had skin problems and ear problems and so forth, but has had a pretty good quality of life.  That is, she’s had a good quality until recently.

When I last saw her at the end of May for a checkup, she was looking good and her blood chemistry tests looked pretty good for a dog her age.  She came in this week and I didn’t recognize her.  She had always been a little plump and now she had dropped from 12 pounds to 9 pounds.  I guess that initially they had been glad to see her lose a little weight at first, but this was ridiculous.  She had also quit eating in the last couple of days.  Her blood tests showed that her kidneys are heading for the last round-up.  Her kidneys should be filtering several wastes out of her blood.  The ones we can measure were about five times as much as a normal dog should have. 

Now if you put a cork in the dog so that it couldn’t urinate, she’d be vomiting and terribly ill long before you got to three times the normal amount of waste in the blood.  When you’re up to five times normal, and still walking around (instead of comatose), you know that the situation has been gradually creeping up to allow the dog’s body to become accustomed to that level of "backed up sewage".  In other words, this isn’t something that just happened. Those kidneys have been on a downhill slide for a long time.  That means that they are not likely to get well.

Ultrasound exam showed that the kidneys, while not normal, were at least not shrunken wads of scar tissue (which would be hopeless).  The first thing you want to do with a patient in this situation is put them on high-volumes of I.V. fluids round the clock. Since the kidneys aren’t taking much waste with each pass of blood through them, we try to ramp up the number of passes and hope to get the dog "flushed out".  That’s a pretty short capsule version, but the bottom line is, she needs to be in the hospital on fluids.  It may not work, but anything else is just watching her starve while her own wastes build up in her bloodstream to toxic levels (her breath already smelled like ammonia).

This is on a Friday and her owner says, "Well, I guess we could bring her in Monday."  "Uh, she might be in really terrible shape in another three days."  "Well, I need to talk to the family about it." "Okay, then…".  They brought her in on Saturday morning and we started the fluids.  It’s going okay so far (ten hours later). 

Here’s the kicker:  the owners (as they were leaving) asked my receptionist if I’d be working on Sunday.  She assured them that I would.  You could have knocked me over with a feather.  I could not imagine that someone (especially someone I’ve been seeing for ten years) would think that I’d just hook up the I.V. line and a REALLY big bag of fluids and then disappear for a couple of days.

It is true that I can get tired of being the day guy and the night guy.  It is also true that I sometimes have to leave town.  And it is also true that I’m not capable of staying in the clinic twenty-four hours a day.  On the other hand, if someone needs intensive care, I’ll just be back and forth a lot.  If I’m going to be out of town, I’d send them to another doctor.  My staff knows I’d never just "put it on automatic" and call it intensive care.  These long-time clients thought it would be better to wait until Monday when "I’d be here".  As it happens, "I’m here" right now at eight PM, have been for two and half hours.  And, like the "governator", I’ll be back.

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