Monday, November 23, 2009

So freaking cool!!

I have a couple of things to comment on tonight; ironically, they are polar opposites.

Today, for the first time in a while, I remembered one of the reasons I chose vetmed. I saw a case that was so completely freaking cool. It was a nice feeling. So, I'm going to present the case and you vet-type people out there tell me if it's not pretty darn neat.

17 week old, intact female, Shih tzu. Has had 2 wellness / vaccine visits (both at the place where I am) since she was acquired from the breeder. First visit, told completely normal. Second visit, grade IV-V/VI heart murmur noted (they even had the cardiologist who was not on duty auscult to verify). No clinical signs of heart disease; an apparently healthy, happy, normal puppy. They referred to cardiology and we saw her today.

Now here's the way cool part. Student goes in and reports a grade II-III/VI murmur and states it was difficult to hear. Hmmmmmm???? Now is the student confused or what? The answer is or what. When I auscultated the dog, quite by accident I caused her heart rate to dramatically increase at which time I heard a grade V (yes, with a palpable thrill, I'm not confused!) murmur but as I listened, without moving my stethoscope, her heart rate slowed and the murmur became a grade II then disappeared completely. It was repeatable. The cardiologist agreed. Is that cool or what? If I could count on myself to be reliable, I wouldn't tell you the diagnosis and take guesses. Problem is I'm too sporadic in my posting and might not answer so I'll spare you the suspense.

So, we did an echocardiogram and found that this puppy basically is trying to be a cat. She has mitral valve dysplasia. Her mitral valve leaflet is very long and creates a functional outflow as her heart rate increases that disappears as the rate decreases. We don't usually see this phenomenon in dogs (not unheard of, just rare) but we often see it in cats; particularly cats with hyperthyroidism. Our cutesy little name for it is SAM=systolic anterior motion. The pup also had secondary hypertrophy of the cardiac muscle. We treated her with a beta-blocker drug to decrease both heart rate and strength of contraction. An added bonus is that the drug has anti-arrhythmic properties (she will be prone to arrhythmias). The great news is that we will likely be able to completely control this problem and with time the hypertrophy will resolve. She may even "grow out" of her dysfunction.

Now just admit that's pretty cool!

My next comment is to simply state that I am in a very pessimistic frame of mind at the moment. Nothing major bad has happened or anything but it seems as if way too much little stuff is piling up and not going right. Was on ER duty this weekend and it was a rough one; got a grand total of 2 hours (spaced apart) sleep over the 34 hours of duty. That doesn't help one's frame of mind to improve. If I had not already paid for a match application I probably wouldn't even bother to apply - that is how convinced I am at the moment that I don't stand a chance of matching. Oh well. Money's paid so can't waste it. I considered a suicide pact with a couple of friends this weekend... If only there had been a sharp object available right at that moment.

Anyway, I have another really cool case that I saw this weekend. It prompted another childish argument between the surgery and medicine services about who would take the case. No, they don't both want it; the problem is no one wants it! It's crazy man! I'll try to post about it soon but want to wait since the radiographs are really neat and I would like to include them.

And I love it that Can't Spell managed a post (sarcasm intended). Like that is enough to make me quit griping at her about it. Still planning something devious to do to her I just don't know when I'll be able to accomplish it.

Until next time...

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