Tales of Woe

Where to begin??? Posting has been infrequent and irregular of late primarily because I've been super busy and frustrated beyond my capacity to express. I don't know what Can't Spell's excuse is - take that up with her.

First I feel the need to complain about the employees. The two young kennel workers are wanting more hours / money but don't want to work any of the shifts where I need them. It's like they expect to be able to waltz in at their convenience or just want to be paid for nothing. Now wouldn't that be nice just to get paid... It's really difficult for me to relate to this because I've always had to work hard for anything I got and was grateful for hours regardless if they were convenient; reschedule the rest of your life if you really need the money!

Continuing on employees, why does everyone have to worry so much about what someone else is doing? I have more than enough in my life to keep me occupied for an eternity without worrying about yours. I'd blame the bickering on the atrocious heat we have right now but the bickering pre-dates it. Then there's the know it alls who still must call me on my day off to ask yet don't really want to hear what I have to say unless it agrees perfectly with their opinion. Sigh...

I am still on a death and destruction nothing will go right kick with my cases. If anyone has any bright ideas to ease my mind on these, you are more than welcome to share! First was a 9 week old small Yorki pup who presented dull and lethargic. I had examined and vaccinated it 2 weeks previously. When it arrived, its exam was unremarkable other than its dull mentation. Glucose level wouldn't read and was covered in coccidia. Owners had fed a raw egg two days previously and the pup had diarrhea. Started IV fluids plus dextrose. Administered an injection of Cerenia and several hours later, after rehydrated, gave oral dose of Ponazuril for the coccidia. The following morning, the puppy looked great and ate some canned I/D food very well. Approximately 45 minutes to an hour later the puppy was dead with an apparrent anaphylactic reaction. To what?!?!?  Maybe I'm crazy, but I'm betting it was to massive coccidia die off.  I can't really find supporting evidence other than that large numbers of mast cells have been documented in chickens with large numbers of coccidia.  It maybe makes sense??

The other very notable case was a 10 year old intact female cat who had been treated for presumptive inflammatory bowel disease that was beginning to worsen. This case haunts me because I feel as if I did it right but it still went bad. Blood work was boring other than a very mild hypercalcemia. Abdominal radiographs showed distended bowel loops throughout. I recommended an exploratory because the cat has a history of ingesting things and I figured we could get some biopsies as well to definitively determine IBD versus neoplasia. Cat was on IV fluids; no, we do not have continuous BP monitoring capability but checks were fine throughout the procedure. There were no foreign bodies so I biopsied the small intestine (grossly normal), the colon (dramatically distended with gas), and the pancreas (abnormal appearance throughout). The cat recovered fairly well, just a little slow but I felt it was due to her becoming slightly hypothermic. I also spayed her and she had multiple ovarian cysts and her uterus was segmentally distended. She went home cautiously two days post-op looking good but needing to be syringe fed. She would take food readily but wouldn't eat voluntarily which we thought might just be due to being picky and not at home. She returned the following day looking like poop and blood work showed kidney failure. She did not respond to therapy at all.  Less than 24 hours later she died.

The biopsies were very non-specific.  There were lymphocytes and some plasma cells, no clear evidence of neoplasia but I know that differentiating lymphoma from inflammatory bowel is tricky under the best circumstances and this cat had been on steroids long term.  The pancreas was odd in that it had amyloid deposition.  It was stated that this can be "normal" in older patients.  Perhaps it is just because most of the herd that lives at my house live well into their double digits but I wasn't really thinking of her as "an older patient."  And why did the kidneys shut down?  My potential explanations include that she did have lymphoma and it was also affecting the kidneys with surgery / anesthesia / medications pushing her over the edge.  Or maybe she had amyloid deposition in the kidneys and, again, all the stressors pushed her over.  Or maybe her kidneys did have chronic changes that were functioning okay until, again, all that was added.  No matter how it falls out, though, I feel like I made a horrible recommendation for surgery to be pursued.  Yes, I can look back and still agree with my recommendation but now that I know the outcome I hate that I made it.  And, yes, I know that the cat might have continued to go downhill even without the surgery but...  Can't help it - not only am I wired in such a way that I take responsibility but it has also been drummed into me all of my life - can't not blame myself.

The boss's brother-in-law's dog is being treated for lymphoma and she is over half through the protocol and has been doing well.  I've tried to stay out of the case since it's his relatives and I'm such a cancer jinx but, of course, I got dragged in Friday to feel the nodes and they are frighteningly large again.  Much bigger than when I last felt her.  The boss is hoping it's just infection; that's NOT what I think.

He dumped the weekend duty on me at 11:00a.m. Friday.  We had seven hospitalized cases.  Thanks for that advance warning.  Six of the seven are doing great.  The seventh is a 15 year old Cocker with a 53,000+ white count and a hematocrit of 13%.  He's treating her for possible tick borne disease which is valid in the South with the non-winter and crazy ticks we're seeing but I'd be looking for the tumor.  Everyone calls me Dr. C because I find so many tumors; I swear, they just jump out in my face without my even looking!!

On that note, my 16 year old Chow / Rotti has a tumor; I'm not sure where the primary is but it's likely it is in the brain or spinal cord.  He had a neurologic episode about 2 years ago which I thought was an FCE due to the rapid recovery and lack of pain.  He showed similar symptoms but seemed mildly painful so I gave him 2 doses of an NSAID in addition to his usual tramadol (for arthritis) which pushed him into kidney failure.  His kidney values were perfect, by the way, which was why I felt okay giving him the drug.  In working up the kidney failure, I took thoracic radiographs and found nodules in the lungs meaning metastatic disease.  The presence of the neurologic symptoms is why I'm thinking CNS tumor.  I'm not putting him through an MRI, anesthesia, surgery, etc. therefore he is on Prednisone now that he is over the acute kidney problem.  Right now, he's doing well although he is being extremely picky about eating.

Can't Spell always says that my having so many geriatrics at the same time is not good for my emotional health and she is correct but what can I do about it?

I tried really hard to think of a good story to tell with light and happiness I've struck out on that.  Sorry.  Guess I could relate the somewhat funny story about how I can hold grudges.  Last September, I sent a neuro referral to my alma mater that belonged to a good friend of mine.  The neurologist there is not the one that I worked with as a student and also is not the one to whom I referred my own dog a few years back.  I hated the way he handled the case.  The only thing good I can say about it was that he reached a diagnosis but, otherwise, the experience was awful.  One of our really good clients who is also one of my personal favorites needed a neuro referral and my boss had set them up for good ol' alma mater.  I asked if she minded going elsewhere and sent her to the doctor that took care of my dog that I liked very much.  Yes, I do hold a grudge if you piss me off badly enough.  Besides, I'm sick to death tired of dealing with people like that.  I've been working very hard to build myself a network of people to whom I can refer myself if the need arises for a specialist.  Yes, I will have to travel for some of them but it is worth it to feel like I'm seeing someone I can trust with my kids.  Half the reason I went to vet school was to take care of my own because I was unhappy with everyone I had used.  I'm still short on orthopedic surgeons...

That's really all that I have time to relate right now other than that I'm working on some first class pranks (stress relief) and my cartoon book isn't going so very good.  I had volume one 98-99% complete and my pesky multiple personalities kicked in with doubts as to whether I really want to share the 'toons with the general public so I started working on all five volumes at once and stopped focusing.  Not sure where that will lead.  With that, I seriously must go to bed as work calls tomorrow bright and early!