"G" came in early this morning on Emergency because she was hit by a car last night. As far as we can tell, she doesn't have any broken bones, but she has really significant soft tissue injuries.
She has a puncture wound over her right eye that made a pocket under her skin that goes back to the level of her ears on the top and all the way over to the left eye. We're managing that wound conservatively with bandages for a while before we really close it up in a few days.
She also had a pretty big abrasion on the front of her right front leg. We're doing the same bandage song and dance on that one.
The big story is her left hind leg which has what we call a "degloving injury." Think about when you're wearing a glove and you peel it off at the end. It's like that, except skin instead of a glove. The skin from her ankle to her toes is missing. There are exposed pieces of muscle and bone. We could manage this with bandages for 3-4 weeks and probably save the leg, but that would cost the owner $6,000-$8,000. Instead, tomorrow we're going to amputate her left hind limb.
I'm really looking forward to the surgery! And I think that she'll feel a lot better once the dead/dying foot is gone.
Wednesday, June 29, 2011
Monday, June 27, 2011
Soft Tissue Surgery- "J"
"J" is a 3 year old Bulldog who has had skin infections since his owner rescued him a year and a half ago. He has a severe infection underneath his tail.
The infection under J's tail, which is what he came in for, is so painful that he screams and bites when anyone tries to examine it. He also has a severe ear infection, a deep chin furunculosis (deeply infected hair follicles) and several other patches of pyoderma (skin infection.)
Overall, he is a little ball of greasy skin infection. And he REEKS. A lot. It's honestly nauseating to stand near him for too long.
Tomorrow, we're doing surgery to remove his tail, which will eliminate the fold the infection under his tail has been growing in. It will also remove the skin that is most affected. After he recovers from the pain of surgery, that should help him a lot. We already consulted Dermatology to help set up a lifelong management plan for his skin problems.
This case just re-inforces for me that Bulldogs are a breed I will never, ever own. What dog (or cat!) breeds do you never want to have?
The infection under J's tail, which is what he came in for, is so painful that he screams and bites when anyone tries to examine it. He also has a severe ear infection, a deep chin furunculosis (deeply infected hair follicles) and several other patches of pyoderma (skin infection.)
Overall, he is a little ball of greasy skin infection. And he REEKS. A lot. It's honestly nauseating to stand near him for too long.
Tomorrow, we're doing surgery to remove his tail, which will eliminate the fold the infection under his tail has been growing in. It will also remove the skin that is most affected. After he recovers from the pain of surgery, that should help him a lot. We already consulted Dermatology to help set up a lifelong management plan for his skin problems.
This case just re-inforces for me that Bulldogs are a breed I will never, ever own. What dog (or cat!) breeds do you never want to have?
Thursday, June 23, 2011
Soft Tissue Surgery- And the surprises keep on coming!
A's CT scan brought even more surprises to her already complicated case.
The CT scan revealed several very small nodules (in the 1-2 mm range.) Beyond that, the radiologists had a hard time agreeing on what the CT scan showed. Part of the process is using the software that comes with the CT machine to evaluate the density of the masses.
One of the radiologists got values indicating the masses were mineral density, which would likely mean that they are benign mineralizations that happen in old lungs. The other radiologist got values indicating that the masses were soft tissue density, which would likely mean that they are actually malignant. And the fact that different "windows" (ways to look at CT images) and different computers give different values indicate that the CT machine is broken in a way the radiologists can't explain.
Either way, benign or malignant, surgery is not the best option. If the masses are benign, then obviously the risks of removing a lung lobe significantly outweigh the benefits. If the masses are tumors, the fact that there are multiple ones in multiple lung lobes makes surgical resection a poor option.
The owner has a follow up appointment in a month with oncology for a repeat CT scan and further advice.
Interestingly, I'm on oncology in a month so I'll get to see how this case ends!
The CT scan revealed several very small nodules (in the 1-2 mm range.) Beyond that, the radiologists had a hard time agreeing on what the CT scan showed. Part of the process is using the software that comes with the CT machine to evaluate the density of the masses.
One of the radiologists got values indicating the masses were mineral density, which would likely mean that they are benign mineralizations that happen in old lungs. The other radiologist got values indicating that the masses were soft tissue density, which would likely mean that they are actually malignant. And the fact that different "windows" (ways to look at CT images) and different computers give different values indicate that the CT machine is broken in a way the radiologists can't explain.
Either way, benign or malignant, surgery is not the best option. If the masses are benign, then obviously the risks of removing a lung lobe significantly outweigh the benefits. If the masses are tumors, the fact that there are multiple ones in multiple lung lobes makes surgical resection a poor option.
The owner has a follow up appointment in a month with oncology for a repeat CT scan and further advice.
Interestingly, I'm on oncology in a month so I'll get to see how this case ends!
Wednesday, June 22, 2011
Soft Tissue Surgery- Sometimes you're in for a surprise
My first day of Soft Tissue Surgery was a day of surprises- for me, the doctors, my patient and her owner.
I signed up for "A", who was in for a mass removal. We had a long fax from her primary veterinarian with pretty much everything that's ever happened to "A" in her care, including a long string of text messages about hookworms.
As far as I could tell from A's record, she had a mass over her right hip that her owner wanted removed. Talking to her owner, she's had masses for quite some time and they've just been there. She had one that came in more recently and seemed to grow more quickly than the other masses. She also had a murmur that had been noted in her record, but her owner hadn't been informed about (which is an entirely seperate issue! Always tell owners about their pets' medical problems!)
Because of her age and the different kinds of masses she had, we opted to do a 3 view thoracic radiographs (aka, "a met check") to see if any of those skin masses had metastasized because if she had lungs full of tumor, it doesn't make sense to put her under anesthesia for skin tumors. On those radiographs, we found a single very small nodule. We did fluoroscopy and rubbed barium on the masses on her skin at that level to make sure it was really a lung nodule and not just her skin masses projected over her lungs. Sadly, it was a lung mass.
Based on that, we really changed our workup. We ended up doing an abdominal ultrasound, aspirating and looking at all her masses under a microscope, doing bloodwork and a urinalysis and doing an echocardiogram (to evaluate her murmur). All the masses are benign, and she's the picture of health for an 11 year old dog.
Tomorrow, we're going to do a CT scan. We can see smaller masses on a CT than on radiographs. If we see lots of masses she becomes an oncology case (because surgical treatment is no longer a possibility and chemo would be the only viable option.) If not, we're going to do a thoracotomy (cut open the chest) and a partial lung-lobectomy (remove a piece of her lung).
So, surprise! You come in for a mass removal and end up losing a piece of lung instead!
I signed up for "A", who was in for a mass removal. We had a long fax from her primary veterinarian with pretty much everything that's ever happened to "A" in her care, including a long string of text messages about hookworms.
As far as I could tell from A's record, she had a mass over her right hip that her owner wanted removed. Talking to her owner, she's had masses for quite some time and they've just been there. She had one that came in more recently and seemed to grow more quickly than the other masses. She also had a murmur that had been noted in her record, but her owner hadn't been informed about (which is an entirely seperate issue! Always tell owners about their pets' medical problems!)
Because of her age and the different kinds of masses she had, we opted to do a 3 view thoracic radiographs (aka, "a met check") to see if any of those skin masses had metastasized because if she had lungs full of tumor, it doesn't make sense to put her under anesthesia for skin tumors. On those radiographs, we found a single very small nodule. We did fluoroscopy and rubbed barium on the masses on her skin at that level to make sure it was really a lung nodule and not just her skin masses projected over her lungs. Sadly, it was a lung mass.
Based on that, we really changed our workup. We ended up doing an abdominal ultrasound, aspirating and looking at all her masses under a microscope, doing bloodwork and a urinalysis and doing an echocardiogram (to evaluate her murmur). All the masses are benign, and she's the picture of health for an 11 year old dog.
Tomorrow, we're going to do a CT scan. We can see smaller masses on a CT than on radiographs. If we see lots of masses she becomes an oncology case (because surgical treatment is no longer a possibility and chemo would be the only viable option.) If not, we're going to do a thoracotomy (cut open the chest) and a partial lung-lobectomy (remove a piece of her lung).
So, surprise! You come in for a mass removal and end up losing a piece of lung instead!
Monday, June 20, 2011
Equine Internal Medicine- Foals
I got a really great text message last night from Dr. Norton, one of the residents I worked with on Equine Internal Medicine, even though I've been off the rotation for a week and a half. She was letting me know that the owners of one of my first equine patients had finally named the foal.
For some background, it is very common for owners/breeders to not name foals until they're older. I don't really know why that is. But, when foals are born, they're called Mare'sName Year'F (F for foal.) My guess is that you don't get as attached to animals that don't have names and that foals (like puppies or kittens) sometimes take very ill and die. It's easier to let an animal go, or to make hard decisions weighing life and finances, if the life doesn't have a name.
But, anyway, my patient was a little foal with significant diarrhea. She was in the hospital for a little over a week, and cost her owners close to $3,000.
They named her Aggie's Special Country Star. They "had to name her aggie because she wouldn't be alive without all or our hard work." That's so sweat! And it feels really good to have all the hard work I did noticed. (I had to do treatments every 2 hours for the first couple days she was in my care.)
For some background, it is very common for owners/breeders to not name foals until they're older. I don't really know why that is. But, when foals are born, they're called Mare'sName Year'F (F for foal.) My guess is that you don't get as attached to animals that don't have names and that foals (like puppies or kittens) sometimes take very ill and die. It's easier to let an animal go, or to make hard decisions weighing life and finances, if the life doesn't have a name.
But, anyway, my patient was a little foal with significant diarrhea. She was in the hospital for a little over a week, and cost her owners close to $3,000.
They named her Aggie's Special Country Star. They "had to name her aggie because she wouldn't be alive without all or our hard work." That's so sweat! And it feels really good to have all the hard work I did noticed. (I had to do treatments every 2 hours for the first couple days she was in my care.)
Friday, June 17, 2011
Cardiology- Heartworm Disease
One of my patients on Cardiology was a 3 year old rescued dog who had been previously diagnosed with Heartworm Disease. While the rescue organization and his new owners have done fabulously by this dog, it makes me sad that so many dogs still get heartworm disease.
Heartworm disease in dogs (and cats!) is preventable by the administration of one little pill a month. Or in the case of cats, a vial of liquid applied to their skin. Most of the time, the dogs even actually like the pill.
Here are some basic facts about heartworm disese that every pet owner should know:
-Heartworm disease is a preventable infection
-Dogs get heartworm disease from being bitten by a mosquito carrying heartworm larvae
-Cats are an atypical host for heartworm, but they can get it. And if you tell me your cat is an indoor cat, I have to ask if you've ever seen an outdor only mosquito. I haven't! I get bitten by mosquitoes inside buildings all the time!
-Heartworm preventative medications are much less expensive than treatment
-Heartworm infection can cause permanent changes to your dog's heart and lungs
-One of the most common signs of heartworm infection in cats is that they just drop dead
In conclusion, make sure your pets get heartworm prevention regularly!
Heartworm disease in dogs (and cats!) is preventable by the administration of one little pill a month. Or in the case of cats, a vial of liquid applied to their skin. Most of the time, the dogs even actually like the pill.
Here are some basic facts about heartworm disese that every pet owner should know:
-Heartworm disease is a preventable infection
-Dogs get heartworm disease from being bitten by a mosquito carrying heartworm larvae
-Cats are an atypical host for heartworm, but they can get it. And if you tell me your cat is an indoor cat, I have to ask if you've ever seen an outdor only mosquito. I haven't! I get bitten by mosquitoes inside buildings all the time!
-Heartworm preventative medications are much less expensive than treatment
-Heartworm infection can cause permanent changes to your dog's heart and lungs
-One of the most common signs of heartworm infection in cats is that they just drop dead
In conclusion, make sure your pets get heartworm prevention regularly!
Wednesday, June 15, 2011
Equine Internal Medicine- "Spitfire"
I feel so blessed to have been involved in Spitfire's life, as short as it was.
He came in as a 10 day old pony foal who had intermittently had fevers, fast heart rates and fast breathing since he was born. When we asked his owners more, they said that he sometimes dribbles milk out his nose when he's been laying down.
When we were looking at chest radiographs to look for aspiration pneumonia, the radiologist said "Well, if this was a dog, I would say this looks like a persistent right aortic arch (PRAA)." We didn't really do much about it then, but when I brought up the radiologist's comment again in rounds, we decided to pursue it a little further. I got sent over to the small animal hospital to talk to people who might know more about PRAAs, because it isn't something that's really reported in horses (9 times in large animals in general, it turns out.)
It got everyone all twitterpated and very excited. He had a lot of very good prognositic factors. After that, it was a very emotional rollercoaster between doing the surgery or euthanizing him.
In the meantime, Spitfire and I really bonded. I named him Spitfire because he had such a delightful personality. He was full of spunk and silliness. He'd walk right up to people and chew on their pants or lab coat. The emergency/overnight students who did his midnight-2AM treatments called him Chompers. He liked to run and buck around the paddock outside when we turned them out in the morning. He liked to steal stethescopes and carry them around his stall. His mother put up with him with goodnatured grace. Overall, he was just a little spitfire. (His owners ended up naming him something else, but I still like Spitfire better.)
Sadly, the surgical attempt to correct his congenital defect didn't go as planned. It ended up going really poorly and he was euthanized on the table. We all knew it was a real long shot that he'd make it, but that doesn't make it any less sad.
He came in as a 10 day old pony foal who had intermittently had fevers, fast heart rates and fast breathing since he was born. When we asked his owners more, they said that he sometimes dribbles milk out his nose when he's been laying down.
When we were looking at chest radiographs to look for aspiration pneumonia, the radiologist said "Well, if this was a dog, I would say this looks like a persistent right aortic arch (PRAA)." We didn't really do much about it then, but when I brought up the radiologist's comment again in rounds, we decided to pursue it a little further. I got sent over to the small animal hospital to talk to people who might know more about PRAAs, because it isn't something that's really reported in horses (9 times in large animals in general, it turns out.)
It got everyone all twitterpated and very excited. He had a lot of very good prognositic factors. After that, it was a very emotional rollercoaster between doing the surgery or euthanizing him.
In the meantime, Spitfire and I really bonded. I named him Spitfire because he had such a delightful personality. He was full of spunk and silliness. He'd walk right up to people and chew on their pants or lab coat. The emergency/overnight students who did his midnight-2AM treatments called him Chompers. He liked to run and buck around the paddock outside when we turned them out in the morning. He liked to steal stethescopes and carry them around his stall. His mother put up with him with goodnatured grace. Overall, he was just a little spitfire. (His owners ended up naming him something else, but I still like Spitfire better.)
Sadly, the surgical attempt to correct his congenital defect didn't go as planned. It ended up going really poorly and he was euthanized on the table. We all knew it was a real long shot that he'd make it, but that doesn't make it any less sad.
Monday, June 13, 2011
Equine Internal Medicine- Toxicity Horses
My first day of Equine Internal Medicine was a little overwhelming! We started the day with 4 students and 13 patients! But, 6 of them were from the same ranch and had all come in together with an unusual neurological presentation.
11 of the family's 20 horses were taken on a trail ride and left in a dry lot pen with a bale of crappy hay afterwards while the family dealt with another problem. The horses ended up eating all the way down to the bottom of the bale of hay, including some plants they wouldn't normally eat. They were also given a normal dose of their normal dewormer.
A day or so later, those 11 horses were in some state of neurological distress. They were somewhere between ataxic ("walking drunk") and recumbent (unable to get up.) The owners ended up bringing in the 6 worst off horses. They got supportive care- fluids, nursing care, etc- and they got better!
It felt like such a miracle! We were so glad to see them all turn around and get better.
11 of the family's 20 horses were taken on a trail ride and left in a dry lot pen with a bale of crappy hay afterwards while the family dealt with another problem. The horses ended up eating all the way down to the bottom of the bale of hay, including some plants they wouldn't normally eat. They were also given a normal dose of their normal dewormer.
A day or so later, those 11 horses were in some state of neurological distress. They were somewhere between ataxic ("walking drunk") and recumbent (unable to get up.) The owners ended up bringing in the 6 worst off horses. They got supportive care- fluids, nursing care, etc- and they got better!
It felt like such a miracle! We were so glad to see them all turn around and get better.
Friday, June 10, 2011
Orthopedic Surgery- "M"
Friday, June 10, 2011
Orthopedic Surgery- "M"
M is an 8 year old Golden Retriever who came in morbidly obese (secondary to recently diagnosed hypothyroidism) and completely non-ambulatory in the back because he had ruptured both his cranial cruciate ligaments.
Cranial Cruciate Ligament ruptures are like ACL tears in humans. If you've ever met someone with an ACL tear, they are incredibly painful! Especially if the medial meniscus gets involved.
We performed Tibial Plateau Leveling Osteotomies on both of his legs at the same time. I got to put in 1 bone screw in each leg! While the first 24 hours after surgery were pretty painful, he was way better than when he came in the day after surgery. It was really awesome to see.
The only problem with him was that his owner was away on a business trip and he ended up spending nearly a week longer in the hospital than he needed to. For a while, M went on a hunger strike. I went through almost every food in our dog food kitchen. I tried puppy food of several brands, I tried the high calorie recovery foods, I tried baby food, I tried hot dogs and hamburgers and chicken breast. He'd eat maybe one bite of anything new then refuse to eat more. Finally, while some of my classmates were eating lunch, he looker interested in their food and willingly ate their leftovers. We were ecstatic! I think he ended up with nearly a pound of turkey and brisket that day. Then we fed.him Turkey lunch meat (with progressively more dog food and less turkey until he was on just dog food.)
Orthopedic Surgery- "M"
M is an 8 year old Golden Retriever who came in morbidly obese (secondary to recently diagnosed hypothyroidism) and completely non-ambulatory in the back because he had ruptured both his cranial cruciate ligaments.
Cranial Cruciate Ligament ruptures are like ACL tears in humans. If you've ever met someone with an ACL tear, they are incredibly painful! Especially if the medial meniscus gets involved.
We performed Tibial Plateau Leveling Osteotomies on both of his legs at the same time. I got to put in 1 bone screw in each leg! While the first 24 hours after surgery were pretty painful, he was way better than when he came in the day after surgery. It was really awesome to see.
The only problem with him was that his owner was away on a business trip and he ended up spending nearly a week longer in the hospital than he needed to. For a while, M went on a hunger strike. I went through almost every food in our dog food kitchen. I tried puppy food of several brands, I tried the high calorie recovery foods, I tried baby food, I tried hot dogs and hamburgers and chicken breast. He'd eat maybe one bite of anything new then refuse to eat more. Finally, while some of my classmates were eating lunch, he looker interested in their food and willingly ate their leftovers. We were ecstatic! I think he ended up with nearly a pound of turkey and brisket that day. Then we fed.him Turkey lunch meat (with progressively more dog food and less turkey until he was on just dog food.)
Wednesday, June 8, 2011
Orthopedic Surgery- "Z"
My first patient ever was a 140 pound Saint Bernard puppy. He came in because his referring veterinarian found an Osteochondrosis Dissecans lesion on both his shoulders after he started coming up lame while exercising.
We confirmed the diagnosis and evaluated the rest of his shoulder joints and both his elbow joints using CT. It still blows me away that we use CT on animals! Z's CT scan made quite a first day for me, because even though he was highly sedated, he jumped off the gurney and tried to take off across the parking lot! Luckily, Wendy (the orthopedics technician) caught his leash as he came off the gurney and he didn't get away. He also slept soundly through his CT scan.
He stayed with us for nearly a week before we did arthroscopic surgery on his shoulders. He was such a handful! Young, exuberant, and strong! I had bruises on my wrists from him pulling on the end of the leash.
We confirmed the diagnosis and evaluated the rest of his shoulder joints and both his elbow joints using CT. It still blows me away that we use CT on animals! Z's CT scan made quite a first day for me, because even though he was highly sedated, he jumped off the gurney and tried to take off across the parking lot! Luckily, Wendy (the orthopedics technician) caught his leash as he came off the gurney and he didn't get away. He also slept soundly through his CT scan.
He stayed with us for nearly a week before we did arthroscopic surgery on his shoulders. He was such a handful! Young, exuberant, and strong! I had bruises on my wrists from him pulling on the end of the leash.
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