Cancer...Unescapable

Well, I have had some sad cases as of late...lots ending in cancer which is sad. Today I had a little Italian Greyhound patient who came in initially to our oncologist and was diagnosed with a lung carcinoma. I unfortunately had to give the owners that news and then set up a CT scan of his chest and abdomen to better define the nodule...in the hopes that it was a solitary nodule and may be operable. He came in today...cute little guy...CT scan unfortunately revealed that the cancer had metastasized not only to all of the lymph nodes in the chest but also to the chest wall...very sad...I had to tell the owners that and they were very sad on the phone - as unfortunately surgery will not remove the disease...you wanna know the little dog's name? Happy...his cute little Italian Greyhound name was Happy...ironically sad. My other patient who I had operated on for 5 hours this past week - to remove a mass from his back - removed half of his back....it ended up to be a mess of a case in more ways than one but I refuse to go in to that...let's just say for those who kno what I am talking about...I did get an apology from my boss regarding the whole case!! So anyhow...his mass came back as extremely aggressive skin carcinoma!!! Not good! Means ultimately he needs another surgery to remove the skin, his scapulas (yes!!) and the spinous processes of his vertebrae (!!) -- No I do not think they will choose to do that. All right, that must be it right? Nope...this morning around 4am I saw an old dog with vestibular disease (think of vertigo in humans)...he had a right head tilt and his eyes were moving very fast in a vertical direction (this is called vertical nystagmus) - and usually is indicative of central vestibular disease...what does this mean??? It means the brain is involved! Discussed with owners MRI/CSF, infectious titers, and imaging of chest and abdomen to r/o other causes, tumors, vascular events (stroke, hemorrhage), etc. Owner declined, did allow full blood work and I started empirically onto steroids (in case of inflammatory disease - such as granulomatous menigoencephalitis which is an inflammatory disease seen in animals) and started antibiotics (TMS - as this crosses the blood brain barrier (meaning it gets into the CSF fluid) and also it is efficacious against many of the infectious agents we may see causing neurological disease). So, I get blood work back and liver enzymes are elevated so I call owner and reccomend ultrasound as I am worried about liver disease. I also discuss cushing's disease, diabetes, hypothyroidism (as these can cause elevated liver enzymes and may predispose to forming clots that may lead to stroke). Later in the afternoon...neurological signs are completely gone...hmmmm. So ultrasound shows large liver mass!! Oh no...so here is most likely what is going on...that is likely neoplastic and yep, probably has spread to the brain. So I discuss with owners that surgery is only option...discuss liver biopsy to find out and then CT scan to define mass and allow for surgeon to evaluate how best to remove. Owner is hesitant so I suggest we do a liver biopsy - which we can do through the skin (percutaneous) with the ultrasound machine...these will take 3-5 days to return and will give them time to spend with her at home and talk about wether or not surgery is an option. If it is, we go on...if not then at least they have a confirmation of cancer and maybe this makes euthanasia an easier, less guilt-ridden choice. So that is what he decided to do. Cancer 3, Ang 0. Ok, moving away from that horrible disease, I am currently taking care of this large cat name Des...he has hepatic lipidosis (fatty liver) from not eating (liver metabolized its stored triglycerides and these end up circulating and back in liver causing accumulation of fat). Kitty is glowing yellow (jaundiced...we call it icteric). We placed a feeding tube in him last night...he is not doing so well, very lethargic, not moving around much. I made him a bed today because he was curled into his litter box with litter stuck in his mouth...so I got him a little cat bed and some blankets and he snuggled right in. We still do not know what caused him to have this episode...I am suspecting GI disease like lymphoma (yes cancer again) or IBD. Biospies of the intestines will probably be needed next...unfortunately bill is already over $2000...but owners are willing to keep going...and hey, this is a bad disease but with appropriate supportive care and the funds to do it they can do well... and I must say....this is totally an internal medicine case and I am loving it!!! I also was taking care of a seizure pet the last couple days...Huskey (of course they are bred for seizures for some reason!!!) and he paced for 2 days straight in his cage, rubbed his nose raw, and finally fell fast asleep right before his owners came to visit...goofy anxious huskey dogs!!! I had a cat the other day Boomer...he was to put it nicely...a bastard!!! Had to knock his butt out just to open his cage door....he has diabetes and accidentally got overdosed by his owner on insulin...so he came in flat out and with glucose supplementation...bounced right up...did fine...sent him home. So..patients aside...only 6 days until I find out the rest of my life...it is scarey but exciting as well...east coast, west coast, midwest??...will I be a resident or not? Hmmmm.... stay tuned. I find out on Monday March 3...unfortunately I will be working, but I check at 7am and I will definitely email and write a blog to let everyone know the results....