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The Heat is on in Surgery 

In the old days when Dr. Lance Coy was my associate it seemed that we had more emergencies than we do today but this may just be what time does to your memories.

We had a veterinary surgeon named Dr. Robin Holtsinger that came up from Lauderdale when we scheduled her for orthopedic surgeries.  She had been doing that for us for about 4 years and the drive was taking it's toll so she called one day telling me that she had another surgeon that just moved to the Stuart area that she really wanted me to meet and hopefully start using instead of her.  I told her anytime they wanted to come was fine...no time was less crazy than any other.

It was a typical afternoon where both doctors were full with appointments.  One of the early appointments was a second opinion for Dr. Coy.  It was a little mini schnauzer that supposedly had a urinary tract infection about a month earlier.  It went to another vet in the area and just wasn't getting any better.  The owner brought the records from the previous vet visit.  No urine sample was analyzed and the only thing that was being done was a combination steroid and penicillin injection.  And the owner was told that it would fix the dog.  No worries.

Well the owner was worried and rightfully so.  Over the past few weeks, little Fritzie had become more and more lethargic.  She wasn't eating well anymore.  And today she had started to stumble when she walked.  When Dr. Coy examined her, he realized that the little dog was in dire straights.  Her breath smelled very uremic, an indication that the kidneys were not working well.  Her temperature was actually below normal as was her heart rate.  She was actually very close to going into shock.  He ran bloodwork, which indicated that her kidneys were having problems excreting the toxins that build up in the body.  Her urine was full of white blood cells (pus) and there were casts of white blood cells which indicates a kindney infection and not just a bladder infection.  On the radiograph, one kidney was much larger than the other one.  He suspected severe pyelonephritis or a kidney infection where the kidney just becomes a bag of pus putting toxins into the body instead of flushing them out of the body.

We discussed what to do next and I recommended Lance do an IVP which is a special x-ray that tells us if the kidney is working.  If both kidneys were not working then there wasn't much we could do.  If it was just the big kidney that was bad and infected then we could remove that kidney and Fritzie could potentially go on to live happily ever after.  Meanwhile through it all, the owners of Fritzie sat in the exam room absorbing one test result after the other and telling us to keep going to try and figure out what to do to help her.  And since this was taking so long I was taking care of both my appointments and Dr. Coy's appointments.  And into this melee entered Dr. Robin Holtsinger with her future replacement surgeon, Dr. Kathy Wander.

It was quite busy and I told them that it would be awhile (maybe never) till I got a chance to talk with them.  Robin asked what was going on and I told her to check in on Lance while I went to see another appointment.  When I next checked in on them they were talking surgery.  The normal sized kidney really was normal and the damaged toxic kidney could be removed with no future harm but the dog was in such a critical, shocky condition that Lance didn't think she would survive.  Robin and Kathy were arguing that she definitely would die if he did nothing.  The owners were willing to take the risk knowing that Fritzie had a 100% chance of dying if nothing was done.  I told Lance that I was handling the appointments so if he wanted to do the surgery, go for it.  Lance had only been out of veterinary school a couple of years and although he liked surgery I think he was nervous about doing the surgery on such a critical dog.  Robin and Kathy said that we were their last stop for the day so they would be glad to stay and help.  Lance didn't have much of a choice at that point, the surgery was thrust upon him.  Not only was he going to have to do surgery on a very critical dog, he was going to have two board certified surgeons standing over and watching him. 

Imagine cooking a meal that you've never prepared before with Julia Child and Emeril Lagasse assisting you.  Now imagine, also, that if you made a mistake, whoever ate your meal would die.  That was the position Lance was in.  He had never removed a kidney before.  He was at one end of a 15 pound seriously ill dog while 3 feet away two board certified surgeons who were acting as his anesthetists and assistants.

As I walked from one exam room to another, seeing both Lances appointments and mine, I would peek my head in on occasion to see three heads over a very small dog covered in a very large surgical drape.  Lance was very sweaty and the two surgeons were very quiet as they continuously worked to keep Fritzie alive.

I found out later that a number of times during the procedure, her heart rate would slow down and Lance would get nervous about continuing but Robin and Kathy would just tell him to keep going and they would handle the anesthesia.  She almost died once but the experience of Robin and Kathy kept her going until Lance finished removing the bag of pus that once was her kidney.

Fritzie survived the surgery and gradually recovered to be a happy normal schnauzer again.  If she were a person, I have no doubt that she would have told her near death story to anyone who would have listened.  Her owners do that for her.

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