Monday, September 8, 2008

so much to talk uninspired to write

i've seen so many cases in the past week - fascinating stuff - but i'm soooooo....soooooo......
apathetic about writing.

on the bright side, this is the 1st sunday i've worked and NOT left hating my job and myself -
despite the fact that before leaving today, i euthanized 2 patients on which i'd exhausted my mental and physical and emotional resources (a heat stroke and an immune-mediated hemolytic anemia).

soo...where to start, where to start????

my first day back (labor day), i arrived at 8am to patients already awaiting. the first was a 10 year old golden retriever with a recent history of coughing up blood (never ever ever a good sign). the other was a 6 year old cat down in the rear limbs.

i took the golden retriever first. the owners reported that he had been coughing up spots of blood for about 2 weeks and had a fever. he saw his regular veterinarian who suspected that he had possible tick-borne disease. the xrays showed "spots" on the lungs of uncertain origin. when i examined the dog i noticed he was limping in the rear limbs. i questioned the owners about the limp and they noted that it had been ongoing for a while. i carefully palpated the area (the rear knee) and was dismayed to find a large, firm mass. i couldn't tell if it was bony - but it was very large. i discussed with them my concern that we were dealing with cancer that had metastasized to the lungs and recommended xrays of the leg and chest. the owners agreed. as i shipped that dog off to the techs, my down in the rear kitty came to the back.

off the golden went for his diagnostics while i turned to the kitty. kitty was 6 years old, previously healthy. the owner had found him down in the rear legs, dragging himself and crying. as i did my physical exam - several things stuck out immediately. kitty's rear legs were cool, the muscles firm. i exposed the nailbeds and noted that they were not pink and healthy but rather blue-ish. i could not feel femoral pulses. the clincher was when i placed my stethoscope on kitty's chest and heard a massive heart murmur. bad news for kitty. (heart murmur + down in the rear limbs = hypertrophic cardiomyopathy and a clot that lodged at the split of the aorta in the rear legs).

at about this time, my xrays were finished. the leg had incredible soft tissue swelling but no destruction of the bone. my suspicion of a soft tissue mass (sarcoma of some sort) went up. and then i looked at the lungs. nodules everywhere. whatever cancer was in the rear leg had gone to the chest and had turned the dog's lungs into swiss cheese.

here i was - fresh back from a week off with 2 cases immediately that had a less than 10% chance of living for much longer than a few weeks - at most.

armed with bad news for everyone, i double-teamed the rooms - delivering my grim reaperish news. both elected to euthanize to prevent further suffering.

as i walked back to ICU with a frown on my face and tears in my eyes, one of the techs placed her hand on my shoulder and said, "welcome back doctor."

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