Busy first day back at work, but everything moved along fairly smoothly. I was stuck there until 7:30pm, 2 hours past the end of my shift, as often happens. A late, complicated case came in and I stayed long after my shift trying to work it all out. It was an interesting day with several very interesting/complicated cases.
Earlier in the day, a cat with acute onset of neurological signs and Horner's syndrome presented. Horner's syndrome describes a condition in which one side of the face looks paralyzed. The 3rd eyelid becomes elevated and covers the eye, the pupil becomes tiny (miotic) on the one side, and the eyelid starts to droop (ptosis). This condition is usually caused by interruption of the innervation to the side of the face where it is observed. Differentials for this are numerous and somewhat surprising as they include a mass in the chest. Why a mass in the chest? Part of the nerve runs through the chest, so compression with a mass can lead to Horner's syndrome. Other causes are severe middle to inner ear infections, tumors in the inner ear, trauma to the shoulder/shoulder area, tumor in the shoulder area, idiopathic (no underlying cause), trauma to the cervicothoracic area, sinus infections, etc. Unfortunately, given the cat's age (15), and the severity of the other signs (including staggering and ataxia), he did not want to pursue either diagnostics or treatment. I ended up euthanizing kitty. I didn't feel good about it, as the cat was oriented and talkative otherwise, but I understood the decision.
Following that came a 9 year old, severely lethargic, unable to stand Golden Retriever mix. She'd been treated at her rDVM for a severe whipworm infestation. They had sent her home that morning, but the owners were concerned, as her condition seemed to be worsening. No bloodwork or xrays had been done. The patient had been diagnosed with severe whipworm infestation and discharged home. When I saw her, I was immediately suspicious of a condition called 'pseudo-Addison's disease' secondary to her whipworms. Addison's disease is a condition in which the body cannot or does not produce natural steroids (needed for every small function of the body, practically). As this worsens, this lack leads to weakness, lethargy, vomiting, diarrhea, a drop in blood glucose, electrolyte imbalances (potentially life-threatening), and eventual collapse. For some reason that I cannot remember pathophysiologically, dogs will develop a pseudo-Addisonian crisis when infested with whipworms.
When I ran my bloodwork, my suspicions were confirmed - high potassium, very low sodium and chloride - indicative of an Addisonian crisis. She has improved markedly already with fluids and is able to stand and walk outside.
And then there was the puzzler at the end of the day. An 11 year old, intact male dog that became acutely lethargic and feverish (104.9). When he came in, he walked with a very hunched posture. His temperature was elevated, and he was very dehydrated. He was also very lethargic, although he managed a slow tail wag when I talked to him. Bloodwork showed possible infection/inflammation. His urine was a horrifying muddy brown color with tons of white blood cells but few bacteria. At this point, I am thinking he is suffering prostatitis - inflammation and/or infection of the prostate gland. This is much more common in intact dogs (virtually unheard of in neutered dogs). Prostatic neoplasia is possible, as is prostatic abscessation. Treatment of prostatitis requires long-term antibiotics and eventual neutering. I hope that I am right about his diagnosis and that I'm not missing something else. That's the scary thing about medicine. You just never know. I've spent some time on VIN tonight cruising articles to determine if I'm missing something...
Sprinkled liberally throughout were the usual frustrations: a woman with a Rottweiler (3 years old) that had never been vaccinated and now had parvovirus. This was her 5th dog with parvovirus, and yet she still refuses to vaccinate. Oh, and said dog has puppies at home. Splendid, eh? Then the Boxer puppy in severe, severe respiratory distress (I suspect electrocution or choking injury) with bloody fluid coming out of its nose. The "breeder" (I use the term loosely) had no finances at all, not even enough to pay for the exam fee. Given the severity of the puppy's condition, I offered free euthanasia. It sucked, as well.
Despite that, I was happy to be back at work, refreshed and interested and in a much better mood. I'm not sure where the mental resolution and cheerfulness came from - perhaps just time in Florida near my grandparents, but it was there!
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