Tough Days at Work

We got dumped on with snow last night...the roads were horrible. I had went over to one of the residents houses with a bunch of the other residents and she cooked food and then we watched a movie...driving home then at night was trecherous. So, I am finally on my days off...had some really busy days at work with some pretty cool cases. One was a German Shepherd that came in for epistaxis (nose hemorrhage). Reg vet had referred over because they had taken blood the day before but didn't have any results back yet...why they did not at least check a PCV/TS in house I do not know but anyway...they dii take an xray and thought they saw a cranial abdominal mass (I know..we are all thinking hemangiosarcoma right? I was). However on my PE I did not appreciate any cranial abdominal enlargement or organomegally, he was slightly uncomfortable but otherwise PE was fairly normal...minus the gigantic pool of blood from his nose!! So I knocked him out (I did not plan to but oops) with some butorphanol and acempromazine, and placed some epinephrine in his nose to stop the bleeding. At that time I was able to see that the bleeding was unilateral from the R nostril (hmmm....I am thinking nasal infection, tumor...). Blood was drawn and showed thrombocytopenia (low platelets), anemia, hyperlactatemia (likely due to decreased tissue perfusion and oxygenation from the anemia, also may be sepsis or if it was a tumor - necrosis), severely elevated total proteins (9.2!!!!!!!), especially the globulins (7.8!!!!!! yikes!!!!)...so now I am thinking infectious vs neoplastic (multiple myeloma??). He is getting ready to go to ultrasound and he vomits a gigantic pile of digested blood. Yuck...ultrasound shows a distended stomach and can't see much else. So I placed a nasogastric tube and pulled about 2 liters of bloody fluid from the stomach (more likely post nasal drip than actually stomach bleeding). Lungs no signs of nodules, bones have no signs of lytic lesions (less likely multiple myeloma). Did another ultrasound after decompressing stomach and saw no mass. Hmmm, at this time I am thinking what is going on in this dog...either cancer I am not finding or infectious. So, I sent out tick titers to test for tick borne disease, clotting times were normal but buccal mucosal bleeding time was prolonged (this indicates some platelet abnormalities). Hmmm....Rechecked PCV'/Ts and he is even more anemic but weird thing is that his proteins have actually increased. Ok, so I check an in-house 4-Dx snap test that tests for some of the infectious disease (lymes, ehrlichia)....and surprise surprise he tests a whopping positive for the Ehrlichia canis (a tick disease)....this can explain all of his clinical signs and blood work...I had already started antibiotics to cover for this (of course...I was thinking see I kinda know what I am doing here!!!) and then gastric protectants, fluids. I went in yesterday and he is still alive and hopefully with the antibiotics will continue to do ok. I had a fun case the other night as well....a kitty with an aural hematoma (big swollen ear filled with blood)...I got to anesthetize her and lance the ear and then place full thickness sutures through to close up the dead space...she has allergies so I told them to follow-up with rDVM to try to get those under better control otherwise she will likely continue to develop these hematomas. Had a dog come in the other morning early...standard poodle...in respiratory distress...had to sedate and intubate her and start breathing for her...talked to owner and she had been sick for 2 days and then this am couldn't get up and having trouble breathing. He was a go for ventilator so I placed her on a ventilator for 12hrs. In the meantime she got chest rads which should horrbile pneumonia and lung consolidation, abdominal ultrasound was boring, bloodwork showed renal disease and liver failure!!! The renal disease cleared with oxygen,,,I think it was hypoxic damage. Now, liver enzymes continue to rise, she is icteric (jaundice). I sent out a toxicology screen and leptospirosis (infectious)to the wisconsin vet diagnostic lab. This could be a result of liver hypoxia as well, but fits most with a liver toxin. So hopefully the screen will show something. She got started on liver protectants and N-aceytlcystine. They did a liver biopsy the other night...and of course she started bleeding from that....so she got her belly wrapped and I believe the bleeding did finally stop. She is still in ICU,, her bill must be around $5000 by this time...but hopefully the liver biopsy will also give us a clue as to what is going on in the liver. She is a very nice dog though...I hope she makes it. Had another dog come in with gun shot wounds...this was at 4am...the owners were getting robbed and the dog and the owners were shot. The owners died and unfortunately I had to euthanize the dog as well because the bullet had went through abdomen and out the side of the chest...pieces of lung tissue were sticking out through the exit wound...and I am sure the GI tract was perforated as well...and since the owners were deceased, MADACC took control and obviously cannot afford a $5000+ surgery so she was euthanized. She had a puppy that apparently was ok. Sad case...it was all over the news that day. Then we had this cold snap and we had a dog brought in to us that had been left outside overnight with no shelter and had frozen to death!!! No comment. I had a small little poodle in heart failure, his second or third episode and so owners elected to euthanize...that was really sad! I am finding even more at this job that the more I seen, the more scared I am when I come home...I am so happy to see both Web and Apache greeting me at the door each night...healthy and happy! I know they are getting older, but I have not stuck my stethoscope on them to listen to hearts or lungs....funny thing is if you ask around the clinic a lot of us vets say the same thing...we don't examine our own animals because we don't want to know!! The day will come but why worry about the future...there is so much to do in the present. My kitties are soaking up the sunshine right now...Ahh to be a cat and not worry about anything...