August 1, 2017


Searching for the BB.

The puncture wound was obvious on the right dorsal flank (Riddler's side up near the spine). It was only a centimeter or so, and stapled together by the vet at the rescue. The technicians clipped off the hair surrounding the wound and scrubbed the area with chlorhexadine while I put on a cap and mask, scrubbed my hands and forearms and unfolded the sterile gloves onto my fingers careful not to touch the outside of glove to my hand... boring! get to the point Dr Noah! Ok, so I put a sterile drape over the sleeping kitty and cut a narrow eye shaped window over the wound and clamped it all in place.. the plan was to follow the BB down the rabbit hole and no doubt find it easily, sitting in a clear open space. I would plunk it into the metal bowl and it would clang just like a bullet from a gun shot victim in the movies.That was not to be.The further I followed down the path, the more obscured it became by the preexisting hemorrhage and trauma, until the trail went cold.Then I heard it, soft at first first, then louder, then louder. hiss! Like air escaping from the slow leak of a tire. Then the beeping of the anesthesia machine, screaming that the oxygen level within the blood was dropping dangerously low. My technician called out that Riddler's tongue had gone purple and his heart rate was dropping.Crap.The BB had passed through the chest cavity (thorax) on its way into the spine, threatening to collapse the lungs in the vacuum created. Fortunately the body had closed in around the hole, plugging the leak.On my hunt, I'd reopened that hole and now air rushed in, compressing the lungs and making it impossible to breath. Riddler was suffocating.Crap.I stitched the tissue closed and threaded a catheter like a straw into the small barrel of the chest surrounding the deflated lungs. I grabbed a syringe and drew the air out while my technicians (Kory and Desi) gave breaths with an ambu bag, through the endotrachial tube into the lungs.. and praise the damn lord, the oxygenation began to increase, the gums went from purple to pink and heart rate returned to normal. All was ok again. Whew Ok, plan b.Left sided approach. I made an incision on the other side of the spine and dissected down to the bone. I could see the artery and vein and nerves feeding in and out of the vertebrae like wires that would trigger an explosion if accidentally nicked. A few X-rays of my hemostat (grabber thingy) grasping the tissue assured that i was directly over the BB. I dug down further but the bone blocked my path. The expert marksman that shot this cat, threaded the BB so perfectly into the spinal column that it was fully encased in bone. There was no way to retrieve the thing without cutting bone and I had neither the tools nor the know how.Crap. So it goes.I sewed riddler up feeling a bit defeated, but after 3hrs of searching, knowing I'd given it my best. Not good enough. So it goes.I was at least able to draw some cerebrospinal fluid from behind the dam, relieving pressure and hopefully improving things. Riddler was slow waking up. I'll keep you posted.There were of course, still the regular surgeries and appointments with 2 dentals, a mass removal, resecting the over grown gums of a beagle with gingival hyperplasia, a cat neuter and 75 pound hound who tried his best to kill me dead. There was the work in euthanasia of our so beloved misty the cat and the emergency Lyme disease outbreak in Doug the Pug.. two new puppies, a tentative breast cancer diagnosis is sweet Lucile the boxer mix.. Murphy with the mouth infection and Finley with allergies.. there was no time for lunch but enough spare moments for a few thousand phone calls.. over the course of the day I received 4 Facebook pet questions and twice as many texts and emails.. on my way home i noticed a voicemail on my cell regarding olive with the hot spot on her way to the ER. I called the owner and almost turned around to head back to the clinic.. but it was after 6pm and I was needed back home. Then Louie swallowed a dried bull penis whole and the owner was calling my cell phone as Amelia cried because she wanted to ride Sadie's bike. 4 kids with Sophia visiting and all with endless energy. It's time for bedtime routine, then back to the clinic to check on Riddler. Surgery begins at 7:30 tomorrow! Happy Tuesday