on to the third year...

I just had to share this picture. I am pretty picky about the photo's I post and tend to shy away from the awful ones, but this was just too funny. She was clearly enjoying her delicious cupcake!

Her 2 year well check went fine. Actually, she did better than she has ever done before, but that still is not without some major screaming and breath holding fits. I like the doctor and will be sticking with this one. A huge relief since we have literally been to 7 different doctors in Avery's short 2 years. Avery just had one shot and will need a flu shot in about a month or so. Other than that she is good to go until she is 3 as long as she is between 23 and 24 lbs by 30 months and doesn't get sick enough to warrant a visit to the doctors office. Crazy!

Avery has started nursery school. She has been twice now and really seems to enjoy herself. I am not sure that I will be able to sneak out yet, but may in a couple more weeks. She really likes another girl in her class and will follow her around and call for her. It is really cute to watch them interact. She has even started to attempt to play with other kids instead of just playing side by side and she has also started to get over her "hatred of boys". That was just embarrassing. I would have to go and explain to the other mom's what was going on because they'd think their kid did something mean to Avery.

Next week we are heading north to Haines, AK on the ferry for a few days. Sam will see a handful of horses up there and Avery and I will just hang out. It should be a fun short trip and it will be nice to get out of the house.

Savikko Park aka Sandy Beach

What a busy week and we still have one more day!

Monday: We headed to the gymnastics academy for open gym! Avery loves this place. She loves hanging from the bars, walking on the balance beam and bouncing on the tramp! We met a little friend there too, we will call her "E". She is a sweet almost 3 year old who was awesome enough to share a terrific stash of size 2T jeans that will seriously fit Avery for at least a year and more likely through next winter. Two pairs are even fleece lined for wintertime!

Tuesday: Turf for Tots is actually every week day from 9:30 AM to 1:00 PM, but the mom's I have met in the area have made Tuesdays the regular day we go and try to meet up. It is an awesome indoor soccer field and they have tons of toys for the toddlers to play with! Avery had a ball!

Wednesday: The weather was terrific so we went for a walk on The Airport Dike Trail. It runs behind the airport and onto the flats. We got to see some giant heavy equipment in action and a bunch of planes land and take off. Avery slipped in the mud and we had to turn back, but we are glad we finally got out to this trail.

Thursday: We went over to Douglas Island and had a play date @ Sandy Beach. We played at the park, in the sand and even let the kids wander the trails a bit. All 3 of the kids seemed to enjoy the driftwood and quarreled over sticks.

Today: We went to the pool! The Dimond (this is spelled correctly) Park Aquatic Center just opened in June and it is an awesome facility. They have a "Lunch Bunch" for an hour every week day. I wasn't sure how Avery was going to do, but she had a FABULOUS time! She even went under at one point (she tripped) and she didn't even react. She even did some swimming in the deeper water moving both her arms and kicking her legs. I am so proud!

Tomorrow: We have birthday party for a little guy we have hung out with a few times, we will call him "H". Pizza and cupcakes is on the menu and depending on the weather we could be headed to our favorite park or Bullwinkles Pizza...I guess we will know in the morning.

Next week we will defiantly head back to the Turf for Tots, maybe the gym and we get to see Kooka and Grandpa next Friday! They will be here Friday through Monday and I am hoping Sam and I can catch a date or two while they are staying! Next weekend will be a fun packed birthday weekend for our big 2 year old!

Vascular Ring Anomaly

Rachelle has been asking me to blog since she started blogging and I've yet to do so. So for the 7 of you out there who might read this, here it is: a post about a case I saw today, structured in the way I try to think when I approach a "work up". It's a very interesting case and an easy diagnosis to make if you know to look for it. It is also rare, I may never see one of these again in my career. My boss has been practicing for 40 years and has never diagnosed one. The owners sound like they will perform the surgical correction, they are taking some time to think about it. I hope they choose to do the surgery, I am very excited to cut this one if they'll let me.

Patient: 8 week old male sled dog pup

Chief Complaint: Since weaning he can't hold any food down. He eats vigorously and almost immediately afterward the food passively comes back up, which he then eats again, and the process repeats itself.

Physical exam: BAR, temp. 100.1, pulse 100 bpm, no murmurs, regular rhythm, lungs auscult clear, mm pink, body condition score 3/9, both testes descended, no abdominal hernias palpable, normal bite occlusion, oral palate normal.

Problem list: Regurgitation (this is not the same as vomiting), thin body condition.

Specific rule outs: Congenital megaesophagus, congenital esophageal stricture, vascular ring anomaly, hiatal hernia, pericardio-peritoneal diaphragmatic hernia, dysphagia, achalasia, gastrointestinal parasites.

First line diagnostics: Offer food and observe.

Assessment: Pup eats ravenously, swallows fine, immediately seems uncomfortable, within 1 minute regurgitates all food.

Second line diagnostics: Radiographs, contrast esophagram with barium.

Assessment of radiographs: Esophageal stricture at heart base, dilated esophagus cranial to stricture, cardiac silhouette wnl, lung fields clear, no evidence of aspiration pneumonia.

Diagnosis: Vascular Ring Anomaly. There are multiple types of vascular ring anomalies described, by far the most common is a persistent 4th right aortic arch.

Plan: Preanesthetic bloodwork and surgery, left 4th intercostal thoracotomy, ligation and transection of the ligamentum arteriosum. Feed high calorie gruel while holding pup upright until day of surgery.

Prognosis: Good to excellent given that there don't appear to be any other congenital defects or secondary aspiration pneumonia.

So there it is, a blog. If interested in pictures and a description of the condition, see this link.

Hope you found this interesting,

Sam Smith, DVM