And So it Ended…Goodbye Belize. Adios.

Things had been a little more quiet at work for a few weeks.  I was not complaining about ending my time at Saga Humane Society on a less hectic note.  However, now that the final days were winding down, it was like they could smell that I was leaving.  Everyone was in a panic to see the vet before she left the island for good.

CAUTION, SOME MILDLY GRAPHIC PHOTOS

On Thursday we lined up a nice final snip day.  Thursday is when we did the majority of our free spays and neuters.  Secretly, this was one of my favorite days.  Not because it was all surgery, but because it was mostly human-free.  Merari in reception knows that unless your dog has a leg hanging off or an eye falling out, Thursday is not for appointments.  I could have a break from the regular stress most vets face in dealing with a variety of clients, questions, and personalities.  On this Thursday one of the staff went out into the community to do some errands and to look for any additional animals that might need spay/neuter.  She returned with an owned dog that was already neutered, but clearly was having trouble walking.  I took a look and thought, “What in the H#@*!??”  This dog had a tumor that I had never seen the likes of before.

Foot Mass

img_5758

I wasn’t really in the market for new challenges, but as a solo vet you don’t always get to pick and choose. I decided to try using the cautery machine (one of the items purchased for Saga with my fundraiser before I  moved to Belize) to help me to remove it, then suture it closed.

Mass Removed from Paw

image1

What a relief for this dog!

We also had a fun goodbye lunch that day at one of the beach resorts.  Sitting out looking over the ocean with the whole staff and a few friends.  We never usually had the opportunity for time like this and I cherished it.

Lunch Out

fullsizerender

Friday was my last full day at Saga.  Twenty animals would be looking for medical care (not a record by any means but enough to keep us on our toes). Eight of these needed an exam with deworming and vaccination, simple enough.  One was an anal gland abscess, yes, this is as horrifyingly gross as it sounds, thank you vet gods for deeming this necessary on my second to last day.  We rechecked a recent adoption with a little hair loss and a lot of itch, performing a skin scrape to identify demodex mange and get him on the road to better health.  One dog was losing weight with a good appetite and we sent off some blood work to Belize City on the airplane.  We tested another with one of our quick snap tests to diagnose him with both heartworm and ehrlichia (tick fever) and start some treatment.  I diagnosed one dog with neck pain and sent home medications and strict instructions, while another complained of bloody diarrhea with muscle wasting.  I rechecked a healing leg wound (doing great) and a broken toenail (needed heavy sedation for full removal and cleaning).  The staff brought in an underweight dog that members of the public had been complaining about due to it’s thin appearance.  A very large dog that was rescued from our sister island of Caye Caulker a month prior came in for a recheck.  Although it was amazing that she had gained significant weight, I also noted that her mammary glands looked huge.  We had no way of knowing previously if she was spayed and really she was not an ideal candidate for surgery at the time.  Now it was obvious that she would need surgery the next morning before I left.  As it turned out, which I suspected when I felt her belly, she was in fact NOT pregnant.  She was having pseudopregnancy (where a dog’s body thinks they’re pregnant and makes milk), so once spayed she went on to do well.  We also picked up a really cute friendly tomcat with a swollen leg.  We got him neutered and on medications so that eventually he could go back to ruling his neighborhood (without  making more kittens!).

So, that leaves just one more case.  A dog who had been in a fight with another dog in it’s home a few days earlier.  The owner thought it was more fresh, but after shaving down the neck I would have had to disagree.  The dog had a thick coat and so a wound could easily go unnoticed for awhile.  I suspect the odor eventually gave it away.  Under sedation we shaved some of her face and most of her neck.  There were some old tooth puncture wounds and just a lot of skin infection, like a big bad hot spot.  She went home looking like a mess but I knew that in a few days it would be a lot better.

Friday night I went home.  It was bittersweet knowing that Saturday morning would be my last regular trip to Saga for work, by lunch I would be done.  I put on my pyjamas, got myself a treat, and sat down on the couch.  Then the phone rang.  Sigh.  It was of course Ingrid, it was an emergency.  She told me hesitantly that it was the same dog, bitten again.  The same dog I just fixed up that same day.  I put on a scrub top and biked back to work alone.  There she was, an even bigger mess than before.  The owners looking embarrassed and exasperated.  Although they had gone home and separated them, the other dog had grabbed her through the small slats in the fence.  I let them know how much I didn’t appreciate fixing up the same dog twice in the same day, but they already knew that there would need to be a change at home.  I took the dog and sent them away for the night.  The wound was in the same area and even though there was a lot of blood, it looked small.  A  tear on the back of her neck.

Dog Bite Wound Surrounded by Skin Infection

img_5771

It would have been easier with help, but I didn’t really want any.  I just wanted to do it alone.  Once she was under anesthesia it was strangely peaceful.  Just me and the dog.  I needed to shave a little more fur, and not having any sharp clipper available left I tried to channel my inner Ingrid and get it done with a straight blade.  I flushed and explored the wound and found it to be huge under the skin compared to the small tooth hole visible from the outside.  I carefully opened up the whole thing.  Even some of the neck muscles were torn apart.  After flushing and flushing and flushing to clean it, I finally put it all back together like a jigsaw puzzle. Placing dozens and dozens of sutures in multiple layers, finally getting to the skin.  Trying to learn from the results of previous cases, I also immediately placed a drain, hoping that all of the tissues would survive and that no abscess would form.  I gave her pain meds and antibiotics and carried her to a cage to tuck her in so I could go home.  I was tired out when I got back on my bike and pedalled home.

Neck Wound Sutured with Drain

img_5773

The next morning would be my last.  I would stay on call for multiple days of emergency but I would not go through my regular work routine again.  I came to Saga and spayed the Great Dane with the milk in her mammary glands from the previous day.  The surgery on this giant breed dog went off without a hitch.  My neck wound dog looked great and was up and about.  I tended to a few appointments and that was it.  At noon I said goodbye, I hugged the staff that had made all this possible, I tried to hold back the tears, and I rode away.  I knew how thankful I was to have had this year in Belize.  How almost no one in my profession would ever get to experience the type of year I just had as a real part of the community of San Pedro.

So many people have thanked me so many times, but it is I who was the lucky one.

 

“Doctora, You Have an Emergency.” A Year of Waiting for the Phone to Ring.

The voice on the other end of the phone was always calm.  Sometimes too calm.  I often couldn’t tell based on the tone whether she meant that someone had called about a broken toenail, or whether a dog had been run over and now it’s skull was hanging out of it’s scalp.  Honestly it could go either way.

How many times could it happen?  During almost ten years as a veterinarian in Florida I had not spent even 1 minute on call.  I moved to Belize and started a year of being on call 100% of the time.  Only when I left the island was I potentially safe, otherwise all bets were off.  Sometimes I was already at Saga in my time off (bonus, no travel time) but often I was in the shower, on the couch in my pyjamas, scuba diving, running, on my bike, or in the gym.  Sometimes I was asleep in bed. Many times I was eating breakfast at Estels Dine by the Sea on a Sunday morning and once ended up pulling bones out of the business end of a dog then saving a chihuahua from hypoglycemia (low blood sugar) back to back while my visiting friends packed my pancakes into a takeout container.

When I look back, I was pretty lucky.  When I got called out on a weekday night it was rare and usually serious.  Most people (and their pets) let me go about my evenings in peace.  It was much more likely to get called in on my days off, between Saturday at noon and Monday evening.  It was also likely to be a dog, as I saw only six cats and one parrot for an after hours emergency.  I looked back at my log to see how the year panned out.  Some of the cases I will never ever forget, others I could barely recall even seeing it on paper.

Types of After Hours Emergency Visits

C-section (the very first emergency, of course!): 1

Dog Bite (never ending): 11

Intussusception (telescoping intestines requiring major surgery): 1 – Hi Mango!

Sick Young Puppy (many reasons): 6

Abdominal Exploratory (oh Ingrid): 1

Injured Parrot (sore leg): 1

Lame/pain (musculoskeletal including spine, legs, etc.): 12

Fractured Limb (some amputated): 3

Post Surgical Complication (don’t act wild after your neuter): 1

Health Certificate for Travel (the best non-emergency emergency): 3

Distemper (not good): 1

Hypoglycemia: 2

Vomiting +/- diarrhea (includes parvovirus): 11

Acutse Allergic Reaction (can you save hives?!): 1

Dead on Arrival (respiratory, very sad): 1

Euthanasia Requested: 4

Urinary Tract Infection: 1

Decreased Appetite (without much other excitement): 2

Hit by Car: 2

Toxin (don’t let your dog eat marijuana, topical medications like creams, plus some unknowns): 4

Bones stuck in the colon/rectum: 1

Gun Shot (drama): 2

Eye Concern (always emergent): 3

Collapse with Fever: 2

Cough: 1

Needed Injections (after hours): 5

Ruined Bandage (I said keep dry): 1

Cat Bite (to the butt of course): 1

Broken Nail: 1

Pyometra (uterus infection – please spay your females): 1

Liver disease (and yellow): 1

As you can see, some were short and easy, some were terribly complicated and took hours.  Most of these types of cases also came up during our regular clinic hours as well.  In the early days the technician attended all the emergencies with me.  As I got more comfortable in the clinic I would try my best to let her stay home, but not only did Ingrid field almost every call, I often needed her help for surgical cases.  There were cases where her teenage daughter ran for towels and opened my suture, and others where I instructed my boyfriend Mick on how to hold off for me to place an IV catheter.  I could never have gotten through all those cases without periodic help.  I remember recently being alone with an owner and her small dog who had been recently attacked by a large dog.  As I started my exam and pain meds she started looking a little faint and I told her, “Ma’am, deep breath, you’re going to have to hold it together because right now it’s just you and me!”

Some concerns were very popular, like dog bites, others thankfully were more rare.  Only four of my emergency cases ended in euthanasia when it was not the original intention of the owner bringing it in (ie. I had to recommend it).  Three died while I tried to save them (1 uterus infection, 1 gunshot, and 1 toxin).  Of course those are the types I never forget.  Some are very satisfying, like sending a momma dog home alive to her nine puppies after a C-section was done to remove her one deceased puppy.  Others are heartbreaking, like staying up all night and having the dog die despite me.

I will say, that when coming in after hours most people are in a more vulnerable position.  They are often panicked at the condition of their dog.  Sometimes the fix was easy and so it felt good to alleviate their fears and send the dog home for what would likely be an easy recovery.  Other times their severe concern was warranted and I knew it would be touch and go.  Some wounds started as a three hour procedure, but then required a month of aftercare to finally resolve.  Either way, clients were always thankful, grateful, and respectful.  Every single person who hauled me out of bed late at night apologized, even though they didn’t have to.  It was appreciated.

Various After Hours Wounds

Foot pad laceration from yard, machete wound sutured, gunshot to abdomen (did not survive), gunshot to head and neck (partially healed), left front leg amputation due to dog bite.

It always feels good to see these pets feeling good with happy owners later on down the road and know that for some of them, we literally saved their lives.

So, to answer the question of how many times could it happen…ninety-one.  I attended ninety-one after hours emergencies.  It was great experience and honestly was much smoother and less scary than I had envisioned before my arrival.  I learned a lot.  I stretched my abilities.

Who needs sleep and free time anyways?

The Wild Wild West

It started on a quiet Saturday night.  I attended a dinner with the staff to say goodbye to one of our own.  We enjoyed food, drinks, and laughs.  I went home smiling and soon put on my PJ’s and headed to bed.  I awoke at 1:30 am and I was already on the phone.  Somehow I had answered while still asleep.  I quickly recognised those most familiar words, “Doctora, you have an emergency.”  It of course, was Ingrid.  She sounded far too chipper, and I soon found out that she was still awake, having not yet been to bed.  Within five minutes she was at my door, picking me up in the golf cart to drive me to work.  Biking around in the middle of the night would not likely be perceived as “safe”, even by me.

As we arrived I immediately recognized the male owner.  He is a well known local that makes one of my favorite unique island drinks.  He and his wife had returned home from a late night shift to find their small friendly dog having difficulty using its hind legs.  After a thorough exam, I gave an injection as well as some medications and home care instructions and we were all headed home once again.  By 2:30 am I was putting my head back on my pillow, having difficulty falling asleep after all of the excitement.

CAUTION: Some bite wound photos.

At 6:20 am the phone was ringing again, this time I looked at the screen before I answered, a number was listed with no name that my phone recognized.  As I said hello, the voice at the other end sounded panicked.  I knew her right away.  She quickly explained that her neighbor’s dog had been attacked by another larger dog.  I instructed her to send them to the clinic and rolled out of bed.  Pulling a scrub top over my head and exercising my self imposed special right to wear flip flops after hours, I hopped sleepily onto my bike and headed to town.  The owner met me minutes later with a small fluffy dog having bite wounds on both sides of her abdomen.  All I knew was that the dog who bit her dog was not her own.  I quickly realized that I would need help, and so as I sent the owner home, I called for assistance.  The dog was soon under anesthesia in order to clean and better assess her wounds.

Bite Wounds on Right Side

img_5521

When it comes to bite wounds there is often more than meets the eye.  On both sides although it appeared like small punctures, they connected to each other with extensive damage to the underlying tissues.  This needed to be opened up and flushed out before being sutured closed.  After a few hours we had everything squared away.  The dog was resting quietly in a cage and I was heading home by 10 am.

Closed Wounds on Left Side

img_5523

I stopped on the way to pick up a few groceries, and as I stood in front of the freezer trying to find affordable bacon, the phone began to ring.  I searched my bag and glanced at the screen, Ingrid.  Sigh.  I answered jokingly, wondering what could possibly be wrong now.  “Gunshot”, she explained sounding concerned, “The other dog involved in this morning’s dog bite has been shot.”  I quickly paid my bill and headed back to the clinic.

I arrived back at Saga to evaluate this large dog.  By all reports from all peoples I met, the shooter was yet a third party, but of course that was for the police to sort out, not me. Unfortunately, many hours had passed since she had been injured and no one had noticed until now.  She had been given an injection for pain and we now started emergency IV fluids.  Her heart was racing and she was covered in blood.  We began washing her down to find the location of her wound and soon found a single bullet hole entering her abdomen from the side.

Bullet Hole into Abdomen

img_5524

This was obviously not an ideal situation even in the most advanced of clinics.  This was a dog who desperately needed a blood transfusion and surgery and  was not likely stable enough for anesthesia.  We got her to a point where we thought it was best to open her up and explore her wounds.  As I cut her belly open from the midline I was greeted by a sea of blood.  Not having any suction here we began to use sterile towels and gauze to find the source.  Quickly I identified a dramatic hole in her small intestine, but could still hear air escaping and smell a foul odor.  Eventually I found a second area with multiple holes where the small intestine meets the colon at the area of the cecum (a small organ that dogs don’t have much use for now through evolution, but animals like horses and rabbits need for digestion).  This meant that mixed in with the blood in her abdomen was feces.  I took a moment to evaluate the entire situation in my mind.  I took off my gloves and asked for the phone.  I explained to her owner the extent of her injuries and my recommendation for euthanasia.  As he agreed with me to go ahead and let her go, sadly, she died on her own.  Although my decision was vindicated, I felt saddened at what she had been through.  What we had all been through.

Finally I arrived back home after 2 pm and put myself back to bed.  Over the next week the fluffy dog with the bites returned to the clinic for a recheck and although her right side was healing perfectly her left side was forming a draining abscess due to the bacteria in the dog’s mouth that bit her.  Despite antibiotics right from the start there was infection and some of the skin was dying.  We decided to hospitalize her for care, using additional antibiotics and honey bandages as well as removing dead tissues as we went along.

Healed on right, Infected on Left

I continued this type of treatment for a week until I felt that I could again make an effort to close the wound.  Soon we went back to surgery and I opened up any remaining pocket, placed a drain to allow the fluid to escape, and closed her up again.

Wound Closed Again, Now With Drain

img_5575

After five more days of maintaining the drain we were able to remove it.  Eventually her stitches were also taken out, but frustratingly a small area in the middle of the wound was open. I started honey bandages yet again to encourage it to heal in on it’s own.  It had been three weeks since the bite happened.

Wound Almost Healed

img_5588

Finally She Can Go Home!

img_5606

In the end, two dogs survived that day of emergencies, one did not.  As I conferred later on with one of the ladies involved on that fateful morning, she said to me in reference to the day’s events, “It’s like the wild west.”  Indeed.

Trauma Drama

Some days, I wish I could escape all the traumatic injuries that I see and treat in the clinic at Saga Humane Society.  There are times that it can be overwhelming.  Dogs that get loose or run free are at such high risk of injury here in San Pedro.  The dog bites, the hit by golf cart (or taxi, or car), the unknown injuries.  It never seems to end.  Although sometimes difficult to enforce, it is actually illegal in Belize to let your dog run free off your own property.  So many injuries that I see would be avoided if owners kept their dogs well secured in their yard, or in the house.

CAUTION GRAPHIC PHOTOS!

Recently the staff was called to go downtown to pick up a puppy that had been reportedly hit by a taxi, the driver did not stop.  Noemy found him cowering in town with severe leg wounds.  He was already waiting when I arrived for the day.  We quickly assessed him, gave him sedation and fluids, and started cleaning and flushing the wounds.

Woopie When Found and His Wounds

 

They were full of dirt and sand, one still had a small vessel pumping blood when positioned in just the right way.  There was enough tissue to close, but there was some tension and I worried about how things would turn out over the next week.  I started him on antibiotics and anti-inflammatories, applied a light bandage to each front limb, and hoped.

Wound Repairs

By the next morning he was up and walking.  As I suspected there was were no fractures involved.  His feet were moderately swollen, which at first I attributed to his overnight bandages, but over the next day they did not improve.  It became obvious that there was an issue, likely a combination of damage to the blood and lymphatic vessels along with the closure I had done were not allowing the fluids to get out of his feet and back to his body.  I waited and watched, hopeful that little collateral vessels would begin to do a bigger job, and sure enough within days he had normal feet once again!  He was a very happy dog.

Big Feet and Being Goofy

Each day we kept a close eye on his progress.  Eight days later I was able to take out many of his stitches.  In the coming week I should be able to finish the job.  It’s challenging to get good photos when the puppy is licking your hair!

Healing Well

Woopie is looking forward to a full recovery.

Recently I was called to a Sunday night emergency, just after I had put on my pyjamas the call came for dog bite.  I hopped on my bike and headed to work.  This was a dog I had examined before.  She had been bitten in the rear leg by a dog that runs loose in the neighborhood causing problems.  The owner could tell that the leg looked broken.  I took one look and winced.  This dog is not friendly to strangers, but at that point she didn’t care.  I gave her sedation to better assess the issue.  Her left hind leg had a few puncture wounds.  Her lower leg was moving in an abnormal direction, and when I felt it I could easily tell that both her tibia and fibula (the bones between your knee and ankle) where both broken about two thirds of the way down.  This dog had no muscle coverage in the injured area, her leg was basically swivelling around.  I knew that a splint would be an effort in frustration and failure.  Her owner is a very intelligent woman and we talked frankly about what to do.  I bandaged the leg for stability, administered antibiotics and pain meds, and we all went home to bed.

The next morning I arrived at Saga fresh from my workout on my day off.  I was prepared for yet another amputation.  Ingrid already had the dog clipped and prepped and ready for surgery.  People often say that dogs are a three legged animal with a spare.  Many dogs can do well on three legs and I knew that this would be the least painful most successful option in the long run.  Although her fracture was low, it is always appropriate to amputate the leg up high through the femur bone.

Leg Amputation Due to Dog Bite

img_4671

By the next day she was already up and around.

1 Day Post Surgery

img_4687

Within forty-eight hours she was back at home with her family doing well.

My final recent trauma drama was a young mix breed dog.  A typical local “potlicker” with the fat lips of a sharpei.  This dog had come from the mainland and had seen a visiting veterinarian on a weekend that I was away.  He had an old infected hind leg fracture with draining wounds on the skin.  This was likely a hit by car.  He was put on antibiotics and told he needed amputation.  This dog had never before been to a vet.

My first time seeing this dog was the day he came for amputation, it had been weeks since he had been in.  He looked happy and healthy but his leg immediately made me uncomfortable.  It was stuck in a straight position and the bone was very thick and weird.  He had some moist scabs high up near the hip.  I could not perform this surgery without more information.  I sent him to the human clinic for an x-ray.  When I got it back I could see that his femur bone (between the hip and the knee) was broken then partially re-healed, but the fractured section was very thick with a irregular hazy appearance.  The problem was quite high up.  Close to the hip, the bone appeared normal.

In the afternoon I set about doing the hind limb amputation.  Luckily one of the pieces of equipment that I donated to Saga from my gofundme (thank you again if you gave!) was a cautery machine.  This came in very handy.

Leg Amputation

When amputating a hind leg there are quite a few annoying blood vessels.  The femoral vein is very large and at times it is hard to tie it off well on the first try.  This was one of those times.  I found out very quickly that the vessel needed to be re-clamped and ligated again.  This is a common minor complication that can be quickly corrected.

A Little Bleeder and Leg Suspended

Once I was down to the bone I used a gigli wire with a little handle at each end, pumping my arms back and forth, back and forth, to essentially saw through the bone with friction by hand.  An assistant (Ingrid) provides counter traction.  This was way too easy, I knew something was wrong.  Upon further examination I could tell that the section I had cut through was dead.  I could not just leave dead bone in this dog.  I spent the next long while dissecting up and around this piece until I came to normal bone and then again, with difficulty, was able to use the gigli wire to cut through to a healthy section.  I also found the splinter of bone that was causing the leaking wounds through the skin.

Section of Dead Bone

img_4622

Finally I was able to flush the area, close the muscles over and eventually the skin.  This was one of the most mentally and physically exhausting surgeries that I have performed in my career.  Sometimes being the only vet is just plain hard.

Final Product Right Hind Leg Amputation

img_4624

The next day the leg looked very good.  The dog was already walking and was eating.  He also had a little bit of bloody diarrhea.  Blood in diarrhea is not uncommon to dogs and he had been through a lot of stress, we dewormed him and started some treatment.  I was still more worried about whether I had gotten all the infected bone out of his leg.  Within a few more days he was vomiting, lethargic, and not eating.  We continued to be aggressive with our treatment.

A week after I literally had blood, sweat, and tears over this dog’s extremely challenging surgery I came into work to find he was dead.  His amputation looked amazing, no signs of swelling or infection, I could not have asked for better.  You see, this dog, as I said, had never been to a vet.  Although he looked happy and healthy aside from his leg, within a day he was exhibiting the first early signs of the parvo.  Parvo is a horrible virus that basically kills off the inner lining of the intestines.  The death rate from it here and elsewhere is very high.  Parvo is preventable by proper vaccination. The timeline from infection to symptoms can range from 3-14 days.

The ending to this story stung like a bee.  There was no time to cry, just a waiting room full of more patients to see.

 

Not So Twinkle Toes

They say things come in three’s. If that’s the case, then whoever is supposed to be keeping count may have lost track.  Over the course of the past month I have seen more than my fair share of digital problems, and I don’t mean the electronic kind!

CAUTION GRAPHIC PHOTOS

My run in with toes started about a month ago with Chispita, a somewhat common name here that translates approximately to “Sparkle”.  Her story was all too common as well.  She had run away for the better part of a week and come back injured.  The source of her injuries will alway remain a mystery, only she knows what she got up to during her island tour.  As soon as she was found she was brought into Saga.  The wounds were to her face and one toe.

Chispita’s Wounds

Clearly not good.  She was clipped and cleaned thoroughly under heavy sedation.

As a basic anatomy review, each dog toe has three bones just like our fingers and toes.  This does not include the dewclaws in a dog (or our thumbs and big toes).  If you bend your index finger, you can easily see the three segments.  Starting closest to the hand (foot) is the first bone, then the second, then the third.  Each toe or finger is called a “digit”.  Each bone in the toe/finger is a “Phalanx”, so we refer to them as P1, P2, and P3. Where P3 is the little one that holds the nail.

So, the end of this toe was visibly a loss and somewhat easily removed.

Bones P2, P3, and Nail

IMG_4174

I thought perhaps I could save the rest.  I tried medications and bandaging, meanwhile also treating her face.  Midway into trying to deal with the toe on a recheck exam I realized I needed to change course.  I reviewed the procedure, and after much bleeding, finding a tourniquet, sweating, and cursing under my breath, the entire toe was amputated.  It looked pretty good!

Post Amputation

IMG_4182

After a little more recovery time, she was looking happy and ready to finally go home.

Chispita Goes Home

Phewf, I thought to myself.  That’s done.

But a vet’s work is never done.  Very quickly I was presented with another toe with a different issue.  This dog had been clawing at her crate door and had caused a fracture and puncture.  She didn’t break the bone in half, she caused the P2 and P3 to separate, leaving the end of the toe wobbly.  Again conservative treatment was not effective and the toe was painful and swollen.  I decided to just remove the last bone, the same way you declaw a cat.  That’s why declaw hurts, it’s not just removal of the nails, it’s an amputation of the last bone and the nail of each digit.  This would be a declaw for medical reasons.  I left the pad attached.

Declaw for Fractured Toe, Before and After

Meanwhile, I was rechecking a dog that belongs to one of the resorts.  This is a very large, scary looking, well behaved dog that comes in with his caretaker.  I see a lot of dogs from resorts and large businesses with caretakers, this is someone who has many jobs and one of them is to look after the dog(s).  Just like with any job, the amount that this person cares or is dedicated varies widely.  Lucky for this dog, the caretaker is one of the most dedicated “owners” that I have come across in San Pedro.  This man’s wife complains that she thinks he takes better care of the dogs than of her!  So, he was concerned that the dog had a new growth near the tip of the toe.  After some medical treatment the growth was unchanged, a very hard, attached, spherical ball.  At the recheck I decided to get an xray, as I really have no way of testing the growth here.

Toe Growth

X-Ray (toe on far right)

 

xraytoe

Growths on a toe can range from infection, to ingrown hairs, to cancer.  I could see that in the x-ray that the middle of the mass was looking calcified (bony) and the P3 looked a little abnormal.  I didn’t like it.  I spoke to the caretaker and recommended amputation.  At surgery I removed P2 and P3 and covered the end with the pad.

Partial Toe Amputation due to Mass

IMG_4227

 

Then we ran into a few hiccups.  Hurricane Earl was bearing down, most dogs here live outside.  I was assured that he could be kept in a dry shed, and he was.  Despite wearing an e-collar, this dog was able to mess with his bandage, the caretaker feverishly doted on him and replaced it as best he could.  Due to the storm damage, he was a number of days late for his recheck.  At that point the toe was infected and I feared a second surgery would be needed.  We started aggressive antibiotic therapy.  At the recheck this week I was so pleased to see it improving!  I am hoping that in a few days this toe will be completely resolved.

Almost Healed

IMG_4344

Feeling a little better about the overall toes situation, I was surprised to receive yet another one!  This was for a dog bite multiple days before that was left untreated.  The toe was infected and too swollen to tell if there was a fracture.  The toe was clipped and cleaned with a light bandage applied for a couple days.  Antibiotics and anti-inflammatories started.  Up close the toe was not as clearly dead as it looks in the photos.  I will recheck this one soon to see if it needs amputation.

Dog Bite Toe

And so, I thought, my toe work is almost done.  Perhaps I could stop losing sleep over losing toes.  Then, a client walked in with a medium sized dog.  A nice lady that I had met previously.  Her dog was wearing a sock…suspicious.  She explained the dog had run away for 5 days, she had a small cut on her foot when she disappeared.  She had recently found her.  She described to me that she thought that the “foot was rotten”.  I sighed, I rubbed my eyes and covered my face for a moment.  I thought I said “why me” in my mind, but I think I may have said it outloud.  I examined the entire dog before removing the sock.  The dog was happy and active.  Finally, unable to avoid it any longer, I gently tugged on the sock.  Ingrid (veterinary technician) was standing a few feet back on the other side of the dog.  I looked down and smiled, because sometimes if I didn’t laugh, I’d cry.  “Is it bad doctora?”, she asked me.

Severe Foot and Toe Injury

“Yes”, I replied. “Are those her bones?”, the owner asked.  “Yes”, I replied.

Another challenge begins.

EARL: 24 Hours in Exile but a Week of Madness.

This week felt like a month.

Let’s back up to the beginning.  It was just last Sunday, but it feels like last year.  July 31, 2016.  I was on our neighboring island of Caye Caulker preparing with nervous excitement to dive Belize’s famous Blue Hole the next morning.  A tropical wave (area of low pressure)  known as Invest 97-L was entering the Caribbean from Africa, or so Facebook and my mother were both telling me.  I would remember to keep half an eye on it’s development.  Monday I did 3 dives and had a great time.  By Tuesday we knew there was trouble.

CAUTION GRAPHIC PHOTOS

Tuesday would be our last “normal” day before the storm.  Now given a name, tropical storm Earl was now on his way to Belize.  During 10 years in Florida I had only had to weather a hit from one named storm, tropical storm Faye in 2008.  I arrived at Saga knowing it would be busy.  We also needed to have an emergency meeting to solidify a plan for all the seventy or so shelter animals. Not only was the schedule full, but Ingrid informed me there was also a dog who needed enucleation (eyeball removal) as hers had been popped out over the weekend…ouch.  We never saw lunch.

Twix Less One Eye

IMG_4245

The Saga board along with Ingrid (tech and shelter manager) and myself decided we would try to get as many animals in foster care as we could and the word went out. We decided we would open the shelter for the morning on Wednesday to facilitate getting the animals into their new temporary homes and closing up for the storm.  I personally had decided that if the storm stayed at a category 1 hurricane or less that we would stay in our home, if it looked worse we would go with a backup plan.  Wednesday morning arrived and Earl was now a Category 1 Hurricane coming straight for us.  It looked like it would approach a Cat 2.  Our house is concrete on the bottom and wood on the top, we live upstairs.  If there’s one thing that this storm taught me, it’s that Hurricane + Wood = NOT GOOD.  I did not want to leave, but I was convinced to evacuate.  At Saga various employees, board members, and volunteers that were staying at home to ride out the storm were sending cats and dogs to safe fosters in droves.  Very few animals had to stay at the shelter and all were able to stay inside.

Saga’s “Fort Dog” Kennels Before and After

Meanwhile we were at home frantically putting our back-up plan into action.  Months ago I met a couple with a dog as a client.  I did not know them at all prior to this.  Their dog was very ill and after a very intensive 24 hours she did not survive.  After this, they invited my boyfriend and I to visit their home on the back side of Ambergris Caye for an afternoon.  It was during this time that they offered to give us refuge if needed during a hurricane.  I remember thanking them but thinking in my mind that it would not be necessary, little did I know.  So, we packed up a few days of clothes and food, along with anything valuable or electronic to take along.  We shoved most of our clothes and shoes into suitcases that we could put high up out of harm’s way in our concrete bodega (shed) that is attached to the house.  I stepped onto our dock and our normally quiet canal was bustling with action.  All of the dive shops were moving their boats from the front of the island to the back, and those from Ramon’s Village resort dive shop were parking here.

Boats from Ramon’s 

Ramonsboats

At 9:40 am on Wed we were picked up at our house by Linda in their boat “Bebe” while husband Cliff was at home prepping their house.  We would be riding out Hurricane Earl at their house, the Casa Brisa (House of Breeze).  We clammered into the boat, myself, my boyfriend, and my french bulldog Cyrano (who definitely can’t swim) for the twenty minute ride to their house on the back of our island.  Mother Nature was just starting to put on a rain shower, but nothing that was indicative of the power she would show through the night.

Bebe

IMG_4263

Cliff and Linda have lived on Ambergris Caye for almost twenty years.  They built the house to be self sufficient and make their own electricity and water.  They have lived through a few monster storms in it and come out well on the other end.  The Casa Brisa house and beautiful property are currently for sale and can be seen at www.casabrisa.net.  We were so lucky to be invited.

Casa Brisa

Casa Brisa Boarded up for the Hurricane

IMG_4258

We quickly got organized for lunch and helped them finish their work.

The Calm Before the Storm

IMG_4259

Cyrano and I in our New Room

We spent the day with full water and electricity keeping busy and following Earl across the Caribbean.  We played cards and drank rum punch.  By evening the wind was howling and the rain was starting to fall.  It looked as though the eye of the storm would be a direct hit on Belize.  After a delicious spaghetti dinner we all sat down for a movie, tired and stressed from a long day.

Cyrano Makes Himself at Home

IMG_4268

By late night Wednesday/early morning Thursday Hurricane Earl was upon us.  The house was solid and I wasn’t afraid, but boy was that wind loud.  A few drops of water rained down on my head from the force of the rain on the hurricane shutters and I fashioned a towel to block it.  I was up many times during my restless sleep but woke up in the early morning hours to just intermittent gusts of wind and zero rain.  My boyfriend Mick was already on the internet assessing the damage.  The beachfront in San Pedro looked bad.  Our neighbor Heather assured me that our house was indeed still there.  Twenty-four hours after we left, we packed up and headed back home.

Our canal was now fully blocked by cross tied boats.  The Ramon’s boats looked snug as a bug in a rug, but sadly it turned out that their dock and dive shop on the other side of the island were completely gone.  We were let off at a neighbor’s yard to walk home.  I dipped a shoed toe tentatively into our flooded street, which was strewn with various types of power lines, before safely carrying my bags and my bulldog back to the house.

Our Street Before and After

We had no power or water but the house and yard looked great.  Even some of my favorite iguanas were there to say hello.  We quickly put everything back in it’s place, ate lunch, and got on our bikes.  First stop, Ingrid’s house, everything looked OK.  Next stop, Saga, Ingrid was busy cleaning up the front yard, she looked exhausted but assured me that all was good.  Next we went on into town.  We parked at the south end and walked the beach north.  I was prepared but still shocked at what I saw.  Every dock/pier was damaged or destroyed.  Most of the small dive shops were gone.  Bars and spas over the water were gone.  When I say gone, I mean disappeared into the ocean or on the beach, not a trace to be found in their original location.  Like they had never existed.

Beachfront Damage

The Palapa Bar, a long time local institution, had recently moved.  I was there enjoying fun and drinks with visiting friends just recently.  The owner is a lovely woman who I crossfit with on Mondays and is a huge doggy lover.  Another crossfitter and recent cat adopter lost Essence Day Spa to the wind and waves. My heart sank for their families.  I have various connections to both owners and employees who’s livelihoods are gone.  I hope many find a way to rebuild.

Palapa Bar Before and After

By the end of Thursday we miraculously had power, but no water.  We had buckets for bathing and flushing along with water for drinking.  I woke up Friday morning and we had both.  I was thrilled.  I got on my bike freshly showered and headed to work.  It was eerily quiet.  Most animals were still with their fosters.  Many people were still evacuated or busy cleaning up their homes and properties.  The day went by easily, but I knew it couldn’t last.  At around 3 pm things started to get crazy.  All at once we had two emergencies on our hands.  The first was a dog with supposed diarrhea and a distended belly.  The picture did not make sense, this little dog was down and severely depressed.  1-2 days of diarrhea with no blood and no vomiting did not cause this.  She had started to act a little off when the storm was bearing down, of course who would really pay attention with all the chaos.  Now she was nearly in a coma.  I could tell things weren’t right feeling her abdomen but I couldn’t determine exactly the source of her severe pain and issues.  My gut told me she might have a closed pyometra, a uterus infection that does not leak fluid from the vagina.  I decided to first stabilize her with IV fluids and antibiotics.

Meanwhile, a happy boisterous boxer mix walked into the clinic.  He had been in a dog fight during the storm and needed repair.  The hanging tissue was badly inflamed and infected.  I put him under anesthesia and set about removing the tissue with my cautery machine and then trying to put his lower lips and jawline back together.

Boxer Facial Injury Before and After

With this surgery complete, I turned back to my mystery abdominal pain dog.  I put her on gas anesthesia and decided to do an exploratory of her abdomen.  As I gently cut her open, pink milky fluid poured out, pus.  I continued on to find a huge pyometra, a uterus infection, that had already ruptured.  I knew her chance of survival was minimal but I continued on.  As I tried to save her by spaying her, her heart stopped numerous times but Ingrid was able to revive her.  I flushed her abdomen as best as I could and stitched her back up.  She made it all the way to a decent stage of recovery before she died again.  We got her back a few times before she finally succumbed to her sepsis (severe infection) and passed away.

Ingrid and I Trying to Save a Pyometra Dog

IMG_4303

Normal Uterus vs Pyometra

This is again why spaying your dog is so important.  The owner remarked that he had been advised to spay her numerous times in the past.  It was almost 7 pm when I biked home.

Saturday morning was our recover from the madness day.  We spayed and neutered 5 animals, dewormed 3 dogs, and vaccinated a puppy.  We contacted those that still had their fosters and happily, a few of the temporary foster homes are adopting their hurricane guests!

The clean up on the beachside continues.  The sun is shining once again.  I am still in awe that virtual strangers who’s dog I could not save invited us into their home during a potentially catastrophic situation.  Some islanders came out of Hurricane Earl with a great loss of business or property, but we all came out with our lives, and that’s what really matters.

 

Adventures with Vet Ventures…From Dogs to Sharks!

We have had a lot of visitors at work over the past 2 weeks!  For months now we have been planning for a group called Vet Ventures to come and help us reach our spay/neuter goals for this year.  They are a voluntary group of veterinarians, technicians, and assistants from the U.S. who aim to bring veterinary care to the animals of the world.  They have done numerous campaigns in the past, visiting other countries such as Peru, Fiji, and Mexico.  One thing that makes this group more unique is that they bring a customized gas anesthesia machine that can do 4 animals at one time.  Gas anesthesia is a safer option than the strictly injectable anesthesia that is often used.

Everyone on the Saga board of directors played a part in making this happen, but members Dawn and Kathy deserve a special thanks for their efforts.  Ingrid also played a huge role in all of what led up to a successful 4 days of surgery here in San Pedro.  It takes a village to make something like this happen!  My involvement was almost completely centered around the actual days that we were hard at work on the ground.  My Saga sponsored experience this year doing a similar type campaign in Roatan, Honduras was very helpful.

In total we visited 4 locations in 3 days.  Vet Ventures brought over 10 team members.  The first was in the DFC (near my house), then San Pedrito, then 2 days in San Mateo.   In each case we were in the yard of a private home.  These are all areas with plenty of intact dogs.  By setting up right in the communities owners have easier access to get FREE care for their pet.  At each location we set up in a similar style, with multiples tents, tables, chairs, and equipment.  It was no easy task.

Setting Up on Day 1

Some owners would bring their dogs and cats to the “front desk” area and check in, others would be picked up and then delivered home later by the saga staff.

Ingrid and Dawn at Check-In

IMG_3457

An Owner Checking In (left), Saga staffers Omar and Noemy Arriving with a Dog (right)

 

Prep and Surgery Areas

Belizean Vet Dr Baptist with Local Volunteer and Vet Hopeful Alexi

IMG_3532

I spent much of my time supervising the recovery area.  I had a handful of excellent volunteers to help me over the 4 days. Some had experience, others had never done anything similar before.  All were attentive and eager to learn.  We had a 100% survival rate each day.

Myself Monitoring Recovery

The Ladies of Recovery, Kathy, Hayley, Heather, Carlijn, Rebecca, and Margie

Even the press came to visit.  Rebecca from the San Pedro Scoop not only volunteered but covered our event in her insanely popular local blog.  The San Pedro Sun dropped by to find out what all the fuss was about. Lighthouse Christian Radio came for an interview with myself, Dr Baptist, and the two group leaders Dr Jennifer Brown and Dr Jennifer Betz.

Press Pictures

Groggy Pets Looking Oh So Cute in Recovery

Overall, Vet Ventures was able to spay/neuter 136 dogs and cats.  They also performed a handful of additional surgeries.  On top of this over 200 additional pets got dewormed, and received heartworm/flea/tick prevention!  It was such a pleasure to be part of this event.

Now, based on the title, you’re thinking….what about the sharks she promised?!  Well, it the midst of all this hard work, the group was able to take a snorkel trip to Hol Chan, Shark Ray Alley, and up north near Tranquility Bay.  They were so lucky to have dive master and boat captain Edgar (Ingrid’s husband and overall great guy) from Amigos del Mar to take them out for a day that can only be described as relaxingly awesome.  Ingrid and I tagged along too!

Snorkeling with Sharks, Fish, and Turtles

Shark Ray Alley

 

Enjoying our Lunch Stop

Edgar Cooking up Fresh Ceviche with Conch we Harvested Ourselves

What a crazy 10 days!!