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...

Am NOT!!!

I did NOT desert y'all!!! It's just hard to think of something to post when you're surrounded by yuckieness.

Every once in a while in vetmed you have a day when cases seem to implode on you.
Today is such a day.

I have the following train wrecks currently in progress:
1) CRF cat that suddenly went anuric and I can't get to make urine with Lasix
2) Several cats with "mystery illness" that have fevers and feel crappy but have NO bloodwork abnormalities except for a MILD increase in WBCs. I'm "shotgunning" them but not much luck yet...
3) A dog with Histoplasmosis. My 5th this year...
4) A cat that had a horrible reaction to her vaccines Saturday and was throwing up all weekend...

You get the picture??? I'll try to post a good story later today...

Saturday, November 21, 2009


Folks, I hate to break it to y'all, but I think we've all been dumped!! Can'tSpell just confessed to me that she has gone over to the dark side and joined Facebook. That means she'll only spend time piddling around on that site and quit blogging:( I feel hurt and betrayed since we have both been fighting the dark side for so long regardless of how many friends had joined and invited us to do so. She says she's just been busy and stressed and that is why she hasn't posted in a while but I think she's been sucked in to the bottomless pit. Hopefully, I'll be proven wrong but readers beware!

Tuesday, November 10, 2009


I am probably the absolute queen of procrastination. At the moment, there are at minimum five other things I should be doing that are more important but I am, instead, posting on this blog. When I'm finished here and before I start the other things I'll probably draw some "Maybes" and by that time it'll just be too late to start so I might as well just go to bed, right? See what I mean. I'm quite good and that is just a sample of an easy scenario.

Today, I diagnosed my 17 year old cat with hyperthyroidism. Veterinarian's pets tend to be like cobbler's children in that we really procrastinate doing diagnostics and treatments for as long as we possibly can and for various and sundry reasons... To tell the truth, I didn't diagnose her today, I only confirmed with rock-solid bloodwork results what I already knew. I mean, how many other diseases would explain an old cat who is not overweight and suddenly exhibits the atypical (for her) behavior of trying to eat food literally out of my mouth? I've noticed this change for at least 6 weeks (probably more) and have been putting off pulling blood and making the confirmation then having to make decisions about treatment. For whatever reason today I brought blood tubes and syringes home at lunch, took her to the bathroom, sat in the floor, and pulled a blood sample. I didn't want to take her in because I was afraid it would stress her out too much. And, no, I didn't have help. I just have an extra hand that no one can see and I only use it when no one else is around;)

It's funny the things you retain well from vet school. I always struggle with endocrine test results. Do I do a free T4 with dogs or cats or when??? Suddenly, today, it made sense. With me, it usually takes either someone saying something in just the right way or my own little mind with its one puny brain cell thinking of it in such a way that it clicks. Duh! You can have euthyroid sick syndrome that causes a low total T4 without true hypothyroidism therefore a dog with a low total T4 would require a free T4 test to confirm hypothyroidism. With that fact, it then logically follows that if euthyroid sick syndrome causes decreases of total T4 but there is nothing that will falsely elevate total T4, then if a cat has a high total T4 you don't have to perform a free T4. The only time to perform a free T4 in a cat would be if total were high normal with suspicious clinical signs because it could be falsely decreased and appear normal. Finally! Check! Got it.

So, my cat has an elevated total T4 with a very mild elevation of her BUN and normal creatinine. We always worry about renal and cardiovascular function in hyperthyroid cats. I have to check her urine specific gravity because I was trying to play ostrich and hoped I would be wrong therefore did not obtain urine. Likely, I'll not have an echocardiogram done either just because of the procrastination issues... Why am I unhappy? After all, hyperthyroidism is usually fairly easy to treat. The problem is that I can't afford I131 (radioactive iodine) therapy which is the best, definitive treatment killing all the abnormal thyroid cells but leaving the normal, functioning cells. Additionally, I need to know that her kidneys will work okay once the thyroid hormone levels go back to normal before I can make that decision. What does this mean? It means that the queen of procrastination is going to have to give her cobbler's child medication twice a day, every day. Know how likely that is to happen??? Yep, you guessed it--not very! I'm gonna have to work hard to get this done. One more thing to add to my lovely to do list that just keeps getting longer. I am very proud to note, however, that she received her first dose tonight! (Wow, this should be recorded in the annals of history somewhere.)

On a different note and in closing for now, I have cajoled, begged, and threatened Can'tSpell to try to get her to post. I even asked if she was just bored with the blog. Her excuse is that she's been either too busy to post or too bummed out by bad cases. I've been trying to come up with a good enough threat to get her behind in gear and the best I've come up with that would work from long distance is to tell her that I'm going to stop sharing my "Maybes" with her. The next step, I figure, will be to tell her I'll stop sharing them with anyone and then all of y'all (yes, I said all of y'all, I am from the south you know!) that get them can yell at her too. Not sure if it will work, but I am trying!