And then you save one...

All is restored in the veterinary career of Ang...why??...because I recently had a great success story, a case I handled all on my own...made the correct diagnosis, set up treatments, and really did save a life!! Here's my story. It was during my am shift last week...got a call from a referring veterinarian about a cat that they were sending over that was in respiratory distress - immediately flags went off in my head and I was thinking lung or heart disease. rDVM says they saw the cat a couple days earlier and took rads that were normal but thought hairball and so gave some anti-inflammatories...I can't say anything but am banging my head against the wall on the other end of the line. Why? Well if it is heart failure then the kidneys already are not perfused and are not getting the blood they need - add on an anti-inflammatory (Meloxicam) and poof..goodbye kidneys! Oh crap! So anyhow...cat comes over...beautiful male neurtered rusty orange Himalayan named Meiko!! Ok..first look and I fall in love with this cat who is open-mouth breathing yet still purring and trying to rub on me. I listen quick and confirm my thoughts...harsh lung sounds, gallop rhythm on heart auscultation, poor pulses, open mouth breathing...I place cat into oxygen cage and go to break the news to the owner....So your cat is in heart failure...no it's not a hairball...here's what we need to do...$1200-1500. They take a minute to discuss and decide they want to at least confirm heart failure - if it is they say they will likely euthanize...sign estimate...ok start diagnostics. Full blood work looks beautiful...good it is not due to other underlying disease but damn this just supports heart failure. I look at radiographs that rDVM called normal - NOT NORMAL!!! Lungs look horrible - large amount of pulmonary edema, heart enlarged -- shoot! Get catheter placed and get cat started onto lasix (diuretic), nitroglycerin (venodilator), and torb to calm. Later able to get a VD radiograph of lungs - yup--still fluid in lungs, still huge heart, huge cardiac veins. Ok...echocardiogram confirms cat has hypertrophic cardiomyopathy. Start benazepril and later atenolol because HR elevated. End up placing onto lasix CRI. Call owners and convince them to give cat overnight to see how he responds to the lasix - owners agree to this. So I hand cat over to Dr. Green for overnight care. I come in am, cat is out of oxygen and breathing normally, lungs sound great!! Yay!!!! I check bloodwork and as expected electrolytes are up and BUN (kidney value) is up - likely due to the diuretic. I start a maintenance rate of fluids and tell owner I would like to keep overnight again - they ok. They come in to visit and are so happy...they thank-me so many times...then comes the question I knew was coming...owner says " so I think our vet may have misdiagnosed the cat and we are thinking we should get all our money back from them" I think quick knowing I want to say - yay they did!! almost killed your cat by telling you it had a hairball and that was why it was breathing heaviy...come on even I didn't have to go to school to know that sounds like quakery. But instead...as I have to keep up good relations and not get others into trouble..say the following : "I cannot say what Meiko looked like when your vet examined him 3 days ago. We are sending over records of his visit here so your vet will have them. What I would do is just go in or call your vet and discuss it". The bad thing for that vet is their physical exam that is written in the record practically screams heart failure along with the radiographs they took!!! Good luck with that one! SO...that was my happy case. For one it was a cat and I love love love them...for two he was the friendliest smoosh faced Himalayan around...and I saved his life...so that his people can enjoy him...even if it is only for a few more months. Maybe I do like this job!

I can't think of a title for this one...

Oh where to start back up again...I have not been writing as much I know I think because my job is getting to me and so ends up not as exciting anymore. But hey...time is slowly coming to an end. I finally got the last July schedule where I see finally in print my last day of July 8 2008. Cannot wait!!! Ok, well I guess I can talk about a few interesting cases I recently saw. It was a referral I saw the other day...came over for anemia but has had nasal congestion for a couple months. So when it came over he was all gurgly and very pale. He was coughing up blood and dripping blood from his nose (epistaxis). So, my thought was something going on in the nose, now is bleeding acutely and causing the anemia. Top differentials: cancer, cancer, cancer, fungal infection, foreign body, cancer. Did I say cancer? So, I got him stabilized, gave him a blood transfusion. The next day he had a CT scan and rhinoscopy procedure....final diagnosis? Yup you guess it...cancer. He went home, probably to pass away as in dogs with nasal tumors, radiation therapy is the top choice - has to be done at UW Madison - of course is wicked expensive...and had very bad side effects on other tissues surrounding the nose (they slough the skin in their mouths=mucositis; their get dry eyes=keratoconjunctivitis sicca; the brain is affected) all of this is because in dogs, we do not yet have the tomotherapy like in humans where you can concentrate the beam on a very small piece of tissue. Sad case. My second case of that same night...a 3 year old (keep in mind the young age) black lab. Has had chronic GI issues for the past month, weight loss, and now she came in flat out, in shock, very dehydrated, pouring liquid bloody diarrhea out of her rear end. I palpate her abdomen and it is very painful and I feel a mass-like lesion mid-abdomen. My first thougth was an intussusception (when one piece of intestine gets sucked into another), cancer was further down on my list. Got her started on fluids and she starts having ventricular tachycardia - converts with lidocaine so I place her on a CRI but she is still throwing fairly consistent VPCs (ventricular premature beats) - is this due to her GI disease or does she now have heart injury as well? Who knows, never got to figure that out...why?...because ultrasound showed a large abdominal mass. We recommend surgery, owners think about it but in the end decide for euthanasia as it is likely not anything good. They allow necropsy so I go ahead and do the autopsy...final? Giant mass encompassing entire root of mesentery and all intestines, then another mass actually surrounding the jejunum (intestine) and obliterating the lumen (opening) - the remainder of the intestine distal to the mass was black...yes, black dead necrotic. Sad...most likely diagnosis....Cancer again. Sad story number two of the night. But at least my next case I saved, for now...it was a ferret that came in non-responsive....checked his glucose and it was only 32----yikes!! So I got him some insta-glucose and rubbed it on his gums and....insta-pet again!! So we hospitalized him on IV fluids with dextrose supplementation. Diagnosis...insulinoma - very common in ferrets - its tumor of the pancreas that secretes insulin thus causing hypoglycemia. In younger ferrets, can sometimes do surgery...usually managed medically with steroids. Anyhow, prognosis is about 6mos to 1 year but still. Ok, that was pretty much my Monday...I have had the last couple days off, luckily did not get called in...now spending my last day off trying not to think about going back!!

Happy Cinco de Mayo!!

Well, ok here I am back again mom!! I know I have been away, like I've said previously I have found this profession suddenly...challenging for me...but alas I think that it may be just this internship and once that is over (in 1 month and 3 days!!!) I will be ok again...I hope because not sure what else I would be very good at. Hmmm, so what have I been up to at work?? Fun stuff...went in on a splenectomy today with our surgeon - sad though because it was cancer and had spread throughout the whole abdomen...so we actually euthanized on the table. Saw a Rottweiler the other day that had gotten hit in the head with a baseball and had bit through its tongue - was bleeding all over the place and had to sedate it quick and suture up the tongue - pretty cool thing!!! What else have I seen...placed a cast on a cat with a broken leg, repaired some bite wounds, saved some, lost some...can't think of anything cool now but I will try and write more later and try better to keep up with the blog. Exciting thing though is it looks like we will be warm weather bound soon...can't wait...I am tired, have been working all day so am going to head to bed.