Monday, December 15, 2008


first day back...not fun. i had a really hard time getting my head straight this morning. i was foggy and kind of just...out of it. that - coupled with the fact that i'd been away from veterinary medicine for a whole week - was a bad combination.

i also found out that i likely mis-diagnosed a patient last week. i saw a 3 year old boxer with gigantic (and i'm talking lemon-sized) lymph nodes. my suspicion (given breed and history) was lymphoma. i did an aspirate (sucked cells out of the lymph nodes and made a slide) and thought it was lymphoma. i discussed sending out the slide to a cytologist for review - explaining to the owners more than once that i am NOT a cytologist and would prefer that one review the slides. they declined, because i did tell them that i was ... eh ... 90% certain of my diagnosis. we discussed further diagnostics, as well - including bloodwork and xrays. the owners declined that and took the dog home to talk about what to do.

that was the saturday before last. i called today to check on the dog because there were no notes in the computer that they scheduled for a follow-up visit. it turns out that the referring vet diagnosed the dog with tick-borne disease after conducting actual bloodwork. after treatment with appropriate antibiotics and steroids (due to the low platelets found on the bloodwork), the lymph nodes are normal in size, and the dog is back to his old self.

i feel rotten. yes, the dog is doing fine - and my mis-diagnosis was caught and no harm done. the owners were actually considering euthanizing this dog though, because he was so sick! they called their vet, and the vet recommended at least doing bloodwork and trying antibiotics.

i'm upset with myself because 1) i saw that my patient was a boxer with enlarged lymph nodes and immediately thought lymphoma (boxers are one of the most predisposed breeds) and 2) the owners might have euthanized him without doing further diagnostics based on my mis-diagnosis.

now, here's the catch. it could still be lymphoma. there's a free animal diagnostics lab in our state, so i sent the slides to them for reading, just to be sure. after spending 20 minutes talking to the (very, very nice) referring vet though, i think she was spot-on with her diagnosis.

and so i feel rotten.

on the bright side, the c-section i did on my last night before leaving for new york is doing well. the puppies are not, 2 were dead in utero and had been for a while, and the 2 live puppies were not fully developed. mama is doing fine though, despite a bloody and frightening surgery.

bleh. not a good first day back. maybe tomorrow will be better.

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