and pleased to be here. I was exhausted yesterday when I arrived, due to the fact that I had to be up at 4:30am to catch my flight. We got back around 12:30 (after having breakfast together), and collectively crashed on the couch for a Lost marathon, as well as pizza and gyros for dinner. It was decadent. Today, I have a list of things to accomplish before heading back to work tomorrow.
In the meantime, a few pearls I picked up at NAVC:
-Unlike dogs, if a cat does not have a heart murmur, it is highly unlikely that they have heart disease. Dogs can have heart disease in the absence of a murmur.
-Pimobendan (Vetmedin) is being used in cats with heart failure now, although the dose is extrapolated from dogs, and there are no scientific studies to support its use.
-Long term use of albuterol inhaled in cats may worsen the inflammation associated with feline asthma. It should be used infrequently and only as a rescue therapy.
-Approximately 90% of proptosed eyes (eyes popped out of the head) will likely need to be removed at some point. They commonly develop problems after being fixed such as ulcers, blindness, and suture loosening.
I'll have to leave you with that for now.
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Stories from the ER veterinarian world
DISCLAIMER
Any similarity between my stories and any person or animal, living or dead, is strictly a coincidence. Names, breeds, sexes, and details of the stories have been changed to protect the guilty and innocent alike.
About Me
- The Homeless Parrot
- I am an emergency veterinarian in North Carolina. Despite the crazy people I deal with, the awful cases of injured and sick animals, and the overall stress of emergency work, I absolutely love what I do. Happily married since I was 20, I have a wonderful husband who has a PhD in Mathematics, and a daughter around whom our world currently revolves. We also have a zoo living in our house that can be alternately wonderful and maddening. There are cats, parrots, and a dog who is very low on the totem pole. Our days are never dull and we are learning to balance the demands of work and family. If you'd like to contact me: homelessparrot@gmail.com
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Medical terminology
- Azotemia - elevation in kidney enzymes (BUN and creatinine) indicating dehydration, kidney failure, or urinary obstruction
- Lactate - a salt/ester of lactic acid that is produced as energy for a cell when oxygen levels are low. In critically ill animals, elevated lactate can be an indicator of inadequate blood flow to organs (perfusion), decreased delivery of oxygen, and/or decreased oxygen uptake. Values > 6-7 are usually considered to be poor prognostic indicators for survival.
- GI sloughing: when the cells lining the GI tract die (can be secondary to MANY things, including heatstroke) with resulting bloody diarrhea, bacterial translocation into the bloodstream and sepsis
- TTJ: transfer to jesus: code for when an animal needs to be euthanized or die
- DIC: disseminated intravascular coagulation: a very, very bad thing - when the hemostatic system gets out of whack, and clots start forming in the blood vessels until all clotting factors are wasted. once those are gone, internal hemorrhage ensues, followed by death, usually. also known as "death is coming"
- Pleural effusion - fluid contained in the pleural space (chest) - this is not the same as fluid in the lungs (see pulm edema) - in cats can be caused by infection in the chest, heart failure, cancer, FIP, feline leukemia, FIV, and in some cases, the cause is never found (idiopathic)
- Anisocoria - unequal pupil size (related to any number of causes including brain damage/head trauma)
- Laterally recumbent - lying on side, unable to rise
- Hyperglycemia - elevated blood glucose
- Hyperkalemia: elevated blood potassium - a life-threatening condition related to several disorders (kidney failure, antifreeze toxicity, urethral obstruction...etc)
- Sepsis - refers to a bacterial infection in the bloodstream or body tissues. This is a very broad term covering the presence of many types of microscopic disease-causing organisms.
- Nephrectomy - kidney removal
- Splenectomy - removal of spleen
- Pulmonary edema - condition in which fluid accumulates in the lungs, usually because the heart's left ventricle does not pump adequately ( can be caused by heart failure, electrocution, drowning, too many IV fluids, to name a few)
- Tick borne diseases - any of a myriad of diseases transmitted by ticks - including but not limited to Rocky Mtn Spotted fever, Lyme disease, Ehrlichia
- Fine needle aspirate - A method of sampling in which a needle is used to suck in cells or tissue bits for diagnoses (good for diagnosing masses/lumps)
- Blood glucose - The principal sugar produced by the body from food–especially carbohydrates, but also from proteins and fats; glucose is the body's major source of energy, is transported to cells via the circulation and used by cells in the presence of insulin (normal range in a dog/cat is 75-100)
- PCV - packed cell volume - the volume of packed red cells in milliliters per 100 ml of blood (normal range 35-45)
Diseases I see/treat frequently
- Dystocia - difficulty birthing. May be responsive to oxytocin administration (Pitocin, as in people) but may require c-section.
- DKA - diabetic ketoacidosis: the extreme end of the diabetic scale. A patient that is diabetic can develop DKA when other diseases make the blood glucose hard to regulate. Other diseases that are commonly associated include urinary tract infection, pancreatitis, pyometra, skin infection, and cancer. In DKA, the body starts metabolizing fat and producing acids that cause a drop in blood pH, nausea, weakness, severe dehydration, electrolyte derangments, and death.
- DCM - dilated cardiomyopathy: an idiopathic (cause unknown) cardiac disease in which the heart chambers become very thin/dilated, and cardiac output drops radically. Causes arrhythmias, tachycardia, and sudden death. Seen in large breed dogs like Dobermans, Great Danes, etc.
- Lymphoma - cancer of the white blood cells, the most common and treatable form of cancer in dogs
- Blocked cat - slang term for a male cat with a plug of mucus and crystals obstructing the urethra (fairly common in male cats) definitely a life-threatening because urine can't get out of the body! If present long enough, causes shock, acute renal failure, hyperkalemia (elevated potassium), coma, and death. Symptoms include straining in the litterbox, yowling while trying to urinate, producing small, bloody drops of urine (also symptoms of feline cystitis, a non-lethal condition)
- GDV - stands for gastric-dilatation and volvulus - a condition of large breed, deep-chested dogs (usually) in which the stomach rotates 180 degrees on its axis and thus - nothing can enter or leave, considered the "mother of all emergencies" - it warrants immediate surgery and carries a guarded prognosis
- IMHA - immune-mediated hemolytic anemia. A disease in which the immune system attacks the red blood cells and destroys them. It causes profound anemia and is life-threatening. Causes are primary (no known cause) and secondary ( tick borne disease, cancer, and heavy metal intoxication). Treatment is immunosuppression with drugs primarily. Prognosis is guarded at best.
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7 comments:
That's funny because I've always heard exactly the opposite about murmurs! I've actually seen cats in full-out heart failure without an audible murmur and my own cat has a 2-3/6 murmur but a full cardio workup showed no signs of heart disease. Interesting...
Anon - it is very true that cats with a murmur may have no disease at all. This speaker estimated that 50% of cats she sees with murmurs have no evidence of heart disease.
On the flip side, the absence of a murmur is USUALLY associated with no heart disease. It is highly unlikely, but like many things, not impossible!
Wow, I had no idea about the albuterol. The cats I've seen prescribed it usually end up on an every other day administration. Do they recommend puffing with any coughing fit then, or only the severe ones? And how do you help the owner tell the difference?
Also, with the proptosed eyes: did they recommend just removing them across the board then? Or is it more of a case where you have to set up the client's expecations and let them know the risks before they choose?
Leahanne: According to the speaker, chronic use of albuterol was shown (in their study) to exacerbate eosinophilic airway inflammation. She recommended using it only as a "rescue medication" - but she did not define what that meant. Her recommendation was not to use it more than 2x/weekly, at the most.
As to the proptosed eye, no, Dr Williams did not recommend removing them carte blanche. He started out the lecture jokingly say, "I can sum this up in 3 seconds. Take them all out." He then went on to say that he gone back and looked at all of his proptosed eyes in the last 10ish years (n=15 or so), and he said that all but 1 had to later be enucleated.
Now, he is an ophthalmologist, so his sample is skewed. On the flip side, I have treated many of these, and they all seem to have complications - usually giant, nasty ulcers - despite ointment application at the lateral canthotomy site, as well as oral systemic antibiotics (which he recommended until the eye is opened up at 3 weeks). So yes, I think he believes that enucleation is ultimately where these are all headed.
Leahanne: He also recommended that if an owner calls you, the proptosis has just happened, and the owner is not squeamish - to have them take a wet, lukewarm wash cloth and push the eye back in. He said that once hemorrhaging starts behind the eye, and the blood clots, reduction is much, much harder.
He said that the eyes that he saved (and has seen saved) were dealt with within 1 hour or less of the initial trauma.
You do have to consider the possibility of being sued by an owner that harms the dog, of course. He explained that England is not quite so litigious.
Welcome home! Glad you learned some stuff, glad you made it home safely and glad you are blogging again!
Ha, I can only imagine the conversations with clients over the phone, if I told them to put their dog's eye back in!
Thanks for all the info, very interesting.
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