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!!