Monday, February 16, 2009

an art, not a science

the little pomeranian i was confronted with was an unusual color. she was a merle - that blackish blue, spotted color that is usually reserved for larger breeds of dog. it was quite attractive, as was her personality as she kissed my face.

her owner reported that she'd developed a harsh cough that day. she'd been lethargic for the past 2 days, and her appetite was decreased. indeed, as i examined her, the cough became evident. it was a hacking, almost honking sound. in an older, fatter pomeranian, i likely would have instantly labeled it as a collapsing trachea. this - however - was an 8 month old puppy.

her physical exam (which i did while i listened to her history) was fairly unremarkable despite a hacking/honking cough, i couldn't hear anything worrisome in the lungs. her gums were pink, her heart rate slightly elevated (but otherwise normal), her abdomen soft and squishy. her rectal and oral exams were normal. she didn't have a fever or big lymph nodes...just a terrible sounding cough.

i turned my attention to her history, as the owner relayed it to me. previously healthy, no current medications, no prior illnesses, up to date on vaccines, never heartworm tested or placed on heartworm preventative. uh-oh.

i recommended a heartworm test. we talked about this for a bit, and then the owner (a very young girl) mentioned offhandedly that the puppy had eaten rat poison about 2 weeks ago. she'd been treated at the rDVM though - with vitamin K tablets. she'd been normal since then. i thought about it briefly, then filed it away for further consideration while we ran the heartworm test.

it was negative. the interesting point was that after drawing the blood, the venipuncture site bled. and bled. and bled. and then bled for a while longer.

in the room, i questioned the owner further about the rat poison. as it turned out, she'd only treated the dog for 7 days with vitamin K. the poison was D-con, which contains brodifacoum - a rat poison that takes 21 days to be eliminated from the body. i asked the owner, 'did you follow up with the vet 3 days after stopping the vitamin k for a clotting profile?' the owner nodded - but it was a slow, uncertain nod. i didn't press the issue, but i didn't believe her.

xrays revealed infiltrates in her lungs. her clotting times were off the chart. i explained to the owner that her dog was bleeding into her lungs, required an emergency plasma transfusion and vitamin K treatment due to rodenticide poisoning.

all went well for the puppy. her clotting times returned to normal within 24 hours of treatment, and she will live to fight another day.

you know why i love cases like these? i could identify a clear problem, and i could offer a clear solution. so often in medicine - the answer is uncertain, the treatment options varied and the research minimal. there are so many times i have told the owners, "i'm sorry, i don't know exactly what is wrong with your pet. i'm going to treat what we can, and i'm going to cross my fingers that i hit the disease process." medicine is an art, not a science. there are so few instances where i can pinpoint the exact problem and the exact treatment. when it happens though, it's reminder anew of how rewarding medicine can be.

1 comment:

Life in vet school said...

Cool beans! Nice case -- and a happy ending! :) Have fun in Raleigh!