Priorities and Treasure

Matthew 6:21 says, "For where your treasure is, there will your heart be also."

I heard a great sermon out here in North Carolina and it was talking about priorities. What is important to you in your life? What do you find occupies your time? Your thoughts? Your. . . wallet?

Now I must say, . . . I love shopping.  Especially for shoes. If you take a quick look back over your shoulder, you will see that I was never that girl. For 28 years of my life, I was not that girl. Ask anyone who knows me. Then one day, it happened.  It was like I found a rusted over key under a rock in the garden and that key unlocked the magical world of my style. 

Well like all legitimate magical worlds, this world has a unique monster.  Its made up of many parts, an arm of vanity, a leg of thrill, even a nose of covetousness.  Anytime you enter the magical world, you risk running into the monster.

Cut to Christmas. This Christmas I bought Jasper a bed.  Now Jasper. . . . . .

Trouble

. . . . obviously doesn't NEED a bed.  She can sleep on any bed in the house, the couches, the window seat, she even takes up Poppy's bed most of the time.  The thing is, I love Jasper and most importantly, the beds were 50% off! 

Within approximately 1 minute and 22 seconds of placing the new bed on top of my bed, Jasper was in it, curled up, content.  It was obvious to her, whom this bed was for.

For Christmas my brother Jon came for a visit!!!! It was completely awesome. We took a great hike at Umstead Park. . . .

This picture makes Poppy look blind, but don't worry, she's just blinking

. . . .we watched movies. . . .

At least I was watching the movie

 . . . .and finally we couldn't keep our eyes open any longer. So we went to bed.

I had put Jasper's new bed on the floor and while I sat in bed reading Charles Spurgeon's thoughts on this Christmas night, . . . this happened.  Furthermore, she would not be moved.  Even when it was very apparent that the bed was not her ideal size.

Not Ideal

Now during the pre-Christmas shopping extravaganza . . . its possible that I went into a shoe store.  BIG MISTAKE.  I bought the prettiest pair of heels.  Really, they were so sweet, but even on sale they were ~$55. 

Today, I returned my beautiful pair of heels.  I slew the monster once again.  A small piece of my heart broke.  Actually it was more of a bruise.  A small bruise.  Well whatever it was, it was fixed almost instantly because I know what my priorities are.  I know where my heart is and that's where I put my treasure. . . and my shoe money.

My Heart

. . . . . .

You can't please everyone I guess

Mom Comes for a Visit

The last month has been spent with severe mixed emotions. With each passing day my expectations of my mom's visit grew exponentially. At the same time, before that visit could take place, I had to face my house officer seminar.

The day of my house officer seminar arrived. Standing in the bathroom, I attempted to bring order out of the chaos that is my hair, all the while going over my presentation in my head. It felt solid, but there was something missing. . . a killer opening line. Whenever I speak in front of people, it is my ambition to gain the crowd from the outset by making them laugh. All the better if I can set them off-balance. Then, it came to me.

I stood in front of the crowd, following my introduction, and I considered the possible adverse affects of what I was about to say. I decided to take the risk.

"Before I begin, . . . I would like to make a disclaimer. . . ." People looked confused.
"My dad, is a minister. . . ." People suddenly looked confused AND nervous.
"He taught me everything I know about public speaking. . . ." More confusion.
"So what I'm saying is, if at some point during this talk, I give an altar call . . . or ask you if you have your own personal relationship with Jesus Christ. . . just bear with me and I'm sure I'll move right on to the pathology."

Well from that point on, they were putty in my hands. The seminar went well and now I only had my mom's arrival to look forward to.

Our time together was incredible! We spent our first three days either driving to, from or through the mountains. It was beautiful! We stayed in a place called Blowing Rock.

The rock formations that give the town its name

Our first afternoon in Blowing Rock

The view!

We struck out early the following morning on the Glen Burney Trail! This trail starts right in the town of Blowing Rock and drops over 600 feet, following a beautiful stream with multitudes of waterfalls.

Mom, the ever intrepid explorer!

 Mom was visiting just when Fall colors were at their peak!

 

Part of the Blue Ridge Parkway

 Our hike finished, we grabbed a hot Reuben sandwich and a cup of tea and headed off to drive a section of the Blue Ridge Parkway.

We weren't that hungry at dinner time but we couldn't beat the view from the Canyon restaurant!

Our next day we decided to get a different type of view of the mountains, . . as only the Riley women can aboard a 4 legged tour guide! When I walked into a small, bare room with a pot-bellied stove and 5 rough looking men with dip in their lips, I thought, "holy smokes. This is it. We might die up in the mountains"

No WAY! It was awesome!!!

Aboard our faithful steads; Black Jack and mom's horse (I can't remember his name)

Well, we had to leave the mountains :( But! We brought a piece of it back with us!

 

Our fun wasn't over. We had one more day to play! So after a great service at The Summit Church and brunch at our favorite local restaurant Mimi's Cafe, we headed over to the State Fair.

 

The fair was chock full of characters . . . . 

 You've never seen so much produce in one place and so HUGE!

There is one thing you must do when you are at the North Carolina State Fair. . . and that is eat something that normally would and should make you completely ashamed. . . such as, fried Oreos. That's right folks.

 

These ridiculously overly indulgent items proved to be remarkably delicious!

Both mom and I felt an overwhelming sense of anxiety as we said goodnight, knowing that I would pick her up in the morning, we would have a quick breakfast and then we would be saying goodbye.

I went to bed depressed and feeling a greater sense of loneliness than I have felt since I moved to NC. While the new day brought the reality of mom leaving, it also brought the reminder that God's mercies are new each day.  I said goodbye to mom and we both took joy in the fact that we are so fortunate to love each other the way we do.

AND! I will be seeing her and all my loved ones soon when I come home for Thanksgiving! Now that's something to REALLY get excited about!

The 4 Stages of the Stack Bandage

For those of you in the equine veterinary world. . . this post will be extremely entertaining.  For those of you not in the equine veterinary world. . . this post will also be extremely entertaining.
"Why didn't she just say that everyone would find this post entertaining?"

I would like to introduce you non-horsey folks to a concept called, "The Modified Robert Jones Bandage." A modified Robert Jones bandage is the single most common bandage used in the equine hospital.

These are your materials, and they are applied in the following order;

1) Combi roll or thick roll cotton

2) Brown Gauze

3) Vetrap

4) +/- Elastikon

The finished product, depending on the leg, location and reason for the wrap, usually resembles this distal extremity, hind limb bandage.

Most horses are very used to having a wrap or boot of some kind on their leg.  Sometimes they are placed for shipping, as in the case of this fashionable little fellow . . .

. . . and most commonly for protection during exercise . . . .

Still, while most horses are used to some sort of bandage on the lower portion of their leg, they are often unaccustomed to having a bandage on the upper, or proximal portion, of the limb.

This is where our story begins; 
The majestic horse. . . .
Graceful. . . .
Elegant. . . .
Athletic. . .
and completely accident prone.

There is a saying that if you place a horse in a padded room, he will find a way to hurt himself and it is 100% truth.  I attribute a great deal of that truth to the fact that horses are prey animals, and as such, their first instinct is to run.  Unfortunately, if you are living in a 12x12 box stall, there isn't a whole lot of room to run. Yah, those walls come up pretty quick.  The majority of horses that I see injured in a truly traumatic event, who are also kept out on a large pasture, are injured by barbed wire.  I don't blame that on the horse.  I blame it on the wire.

So what happens when a horse injures their carpus (knee)?

or tarsus/hock (ankle)?

Well that's when you have to place a STACK BANDAGE. A stack bandage is just one modified robert jones placed above another, in an ascending fashion, with some overlap of the bandages.  This does several things.  It covers the affected area and it also decreases the mobility in the limb.  This is particularly important if you have a wound over a high motion area or a joint, like this one on the dorsal (front) aspect of a horse's hock. . .

The problem with these bandages is that you are taking a flight animal and essentially immobilizing or greatly reducing the mobility of one of their legs.  How well do you think that goes over?  Well it goes over something like this. . .

First, the horse is sedated to apply the bandage.  I call this the "blissfully unaware" stage.

Stage 1: Blissfully Unaware

Secondly, as the sedation begins to wear off the horse enters stage 2 or the "Recognition" stage.

Stage 2: Recognition

Thirdly, the sedation is blasted off its receptors by a surge of adrenaline and the horse enters the third, "Escape" stage.

Stage 3: ESCAPE!

Stage 3 or "Escape" stage, can go on for a prolonged period of time.  The horse seems to be convinced that there is a lion or bear attached to its leg.  Rather than attempting to use the limb, it chooses holding the leg up at a nearly 90 degree angle to its body, which inevitably causes it to fall away in the opposite direction.

I have literally seen entire rooms destroyed by a horse in the "Escape" stage as it levitates its limb around the room while simultaneously trying to run away from it.  The best thing to do is to try and get these horses moving forward.  There are rare occasions where a horse does not make it past "Escape" stage and the bandage has to be modified further.

However, most horses at least make it to their stalls, where they enter the fourth stage, "Resignation" stage.

Stage 4: Resignation

Horses in "Resignation" stage may be resigned to the situation, but they are still convinced that there is a lion attached to their leg.  Horses in this stage often will not move, even for food, and it is important to make sure they are within reach of food and water.  Upon moving, "Resignation" horses may lapse back to the "Escape" phase, as they are further reminded of the bear on their hind limb.

Then one magical day, you walk into the stall and the horse is walking around and acting like nothing ever happened.

It can be frustrating working with these horses.  Here you are trying to immobilize their limb and they are doing acrobatic feats just to get away from your stack wrap.  Its important to remember that they are a flight animal and that they simply don't understand.  Everyone gets frustrated with them at times.  Especially when you take the magic worm-hole and go straight from stage 1 "blissful ignorance" to stage 3 "Escape" in the middle of trying to wrap the leg.  Usually in these moments all the bandaging material goes flying, becomes ripped or falls to the ground and you are left to start all over again.  Still, if it wasn't challenging, anyone could do it right? 
That's why we became horse vets right?!
We bandage the unbandagable!

Until next time!

Sitting on a colic

Well, I'm sitting here in medical records. What am I sitting on? Literally or figuratively? Literally I'm sitting on a stool at a computer. Figuratively, I'm sitting on a colic. That means, I'm waiting to see if it needs to go to surgery or not.

Now on some level, every colic is exactly the same.  For those of you who don't know, a horse that is colicking is a horse with a belly ache.  I could go into all the details of extra-gastrointestinal reasons for colic, gastrointestinal reasons for colic, colic of the small intestine, colic of the large intestine, strangulating vs. non-strangulating but suffice it to say that a colic can be caused by many things.

Likewise, the horses show up with varying clinical signs. This last weekend I received 5 colics. . . . I'm just going to let that sink in with you. 5. 5 colics. Okay lets move on. So I had these 5 sick horses show up over the weekend and this was what they looked like.


Horse 1: Looked a little crampy, a little bit sweaty, and needed sedation to stay comfortable.


What Horse 1 looked like (not actually horse 1)

Horse 2: Looked like it was put out at having been dragged out of bed at this hour. Couldn't, for the life of it figure out what we were doing or why.

What horse 2 looked like (not actually horse 2)

Horse 3: Arrived agitated and threatened to do several of us bodily harm because he was scared. Became painful enough to kick out while in the stocks. . . very nearly taking my femur with him, and needed sedation to calm down.


What horse 3 acted like (not actually horse 3)

Horse 4: Showed up in a full body sweat. This horse was attempting to throw itself down onto the ground in fits of pain and was refractory to all but the strongest of pain medications we could give it intravenously.

What Horse 4 looked like (not actually horse 5)

Horse 5: Arrived at 5am (sad face). This horse was more worried about the muzzle we put on its nose, than its belly ache.

What Horse 5 looked like (not actually horse 5)

So there you have it, the spectrum. Generally speaking we think of horses with worse lesions being more painful. "Wow, did you go to vet school to learn that kind of logic doc?" BUT! These are horses. . . so that's not always the case!

Lets look at our 5 horses and where they are at. . . 5-6 days later.

Horse 1: Horse one is doing well. She is happy eating in her stall as we speak and should be going home relatively soon. That sort of makes sense.

Horse 2: Horse 2 is still in the hospital as well. However, it looks like either secondary to or as the primary cause of her colic, she may break with colitis. She has developed fevers and is quite sick. Unexpected, is it not?

Horse 3: Horse 3 never acted colicky after his initial presentation. We sent him home very quickly because there was nothing that needed to be done. 1 day later, he was back and has since demonstrated the "colic" behavior that the owner described.  However, this behavior may not in fact be colic at all but seizure or some other type of hyperesthesia (hypersensitivity).

Horse 4: This horse was so painful we were drowing her in pain medications. She needed to go to surgery but the owner really couldn't afford it (understandable because the average colic surgery is approximately $8000 dollars). We didn't give her much of a chance with her level of pain and I was sure I would get a call around 2am to come and put her down.  Yet, when I walked in the next morning, there she was, standing, bright, alert and comfortable. Well bust my buttons was I surprised. She continues to do well.

Horse 5: Discharged 2 days later with no complications and happy as can be.

Suffice it to say, you just never can be 100% certain with a colic. They'll surprise you.
So as I sit here. . . I wonder. . . where will this horse come out? Will we have to take him to surgery? Will he buck up and come through on his own? How much longer do I have to sit here, before I get to go to bed? Can I sleep on a stool in an upright position?