Friday, April 11, 2008

Wow, I'm just beat!

I've been working for M for the last 3 days - her kids are tracked out and she took them up to Boone/Blowing Rock for a mini-vacation. I had to leave at 7:30 to get to her clinic by 9 (damn Cary traffic!!); her girls are great so it wasn't the work that was difficult - but long days and long drives always do me in!!

I saw some interesting cases... managed an 18yr old cat in CRF, had a chihuahua vomiting up strange substances and having subsequent anorexia/ileus, did a 2+ hour cystotomy today (spiculated stones were lodged in the urethra and were very difficult to retropulse for removal!! - and this in a dog that had already had a PU!!), and then I had to put down one of her clients this afternoon - a 14yr old German Shepherd... really sweet dog, and I generally don't like the shepherds - of course, she was really sick when I "met" her and that may be a lot of the reason she was so sweet. Anyway, she came in yesterday, hadn't eaten in a WEEK! Okay, I know the owner's love her and all, but really, who waits until the old dog has gone an entire week without eating before you even begin to wonder if something is wrong?? Anyway, that notwithstanding, we sent out blood work and he took the dog home pending results - her PE was really unremarkable except for the fact that she was very thin - but then again, she WAS 14 years old! Anyway, the blood work and urinalysis were totally unremarkable - amylase was a little elevated, but lipase was down, she was mildly anemic (hct of 26), some Howell-Jolly bodies (hadn't actually seen that in a patient before and couldn't remember from clin path so we had to look up the significance) with an elevated white count (15.5k), nothing else worth noting, really... her owner called back right at 9am today to say that she had gone out to pee this morning and there was a thick yellowy discharge from her vulva; the dog then came inside and collapsed. The owner reported that she ate last night and they were thinking that they had brought her in to me for nothing... but today she was shaky and weak - so they brought her back. Today she was much paler than yesterday and her abdomen seemed a bit inflated compared to yesterday, and it was definitely "doughy". Given that one of the primary causes of Howell-Jolly bodies is "hyposplenism" - and this dog had NOT had a splenectomy recently... my biggest concern is that she had splenic masses and has had a bleed. So, we recheck her PCV and today it's less than 14!! Oh, yeah... that's a problem! Jeanne called the radiologist and he showed up about an hour later to do an "emergency" u/s... the abdomen was full of echogenic fluid (most likely blood), he found a 10cm mass in the spleen with very little normal splenic tissue and containing multiple fluid filled cavities; similar lesions in the liver. Primary differential - hemangiosarcoma with mets to the liver. During the u/s, the owner turned to me and said, "you were dead on." Yeah, well sometimes it sucks to be right!! No treatment, no hope, really... the owner took the dog home so the family could say "good-bye" - they were back at 5pm and we put her to sleep in the back of the van. Poor girl - I just wish they hadn't waited so long to try to find out what was wrong with her. Brought back flashes of the splenic issues with Saphira, too, and that hurt my heart!

There's really nothing else going on... I'm off for the weekend and hope to get some things done; I'd like to do some work outside, but it's supposed to be cold with thunderstorms... figures, huh?? It was absolutely beautiful today!! Sunny with a high of 83!