I hate how good owners always seem to have pets with terrible diseases. It's such a cliche in veterinary medicine. Probably in human medicine as well.
Last week, I was presented with a nice, small breed dog late at night. His owner was concerned because he'd suddenly developed very, very bloody urine, as well as lethargy. As I examined the dog, my heart sank. He was dehydrated, depressed, and his gums were yellow-tinted, as were his eyes and inner ear pinna. Jaundice coupled with bloody urine usually means that the body is hemolyzing its own red blood cells (IMHA - see sidebar).
My testing confirmed this terrible disease, and I delivered the news to his owner. IMHA carries a fairly grim prognosis. Partly because it's a really bad disease and partly because it can be very, very expensive to treat. Owners often end up euthanizing because the cost is too great.
In this case, the owner wanted to try, so we started with a blood transfusion. Unfortunately, my patient rapidly hemolyzed it, leaving him more anemic than when we started. He also developed evidence of disseminated intravascular coagulation.
After much soul-searching, his owner elected to euthanize him. I can't say it was the wrong decision, given the rapid deterioration, but it was still such a downer. His owner loved him very much and cared for him very well.
Life is not fair.
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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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2 comments:
AH, over the years I've lost two dogs to IMHA. The first, a mixed breed (poodle-shelty) and the second eight years later a purebred mini-Schnauzer. Both were exactly eight years old. The first dog was treated with prednisone only. She should have been euthanized but instead she died a painful, horrible death. The second dog (male), we tried everything. Blood transfusion, prednisone, but I couldn't save him. I loved him very much and held him as he was euthanized. It's a horrible, horrible disease and I wouldn't wish it on any animal or owner. Sigh.
In medicine, the truism is "Nice guys have the worst diagnosis." So bemoaning the fact that a patient was was a nice guy and the biopsy was cancer, I would always hear "You said he was a nice guy, what did you expect?" Made me want to be a jerk in self-defense. Wonder if that thought pattern explains some surgeons?
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