Cocker Update

The little guy went to radiology again last night, and a large fluid filled mass was found in the cranial abdomen. The veterinarian suspected GDV (gastric dilitation volvulous). This means that the stomach became full of air (usually from aerophagia) and then twisted upon itself. It is considered a medical emergency. This is a condition that ususally happens in large and giant breed dogs (ex. great danes), but it can happen in other breeds too. The veterinarian is considering emergency surgery. In surgery, the veterinarian will correct the twist and most likely suture the stomach to the body wall so this sort of thing won't happen again. When the stomach twists like that, arteries and veins are twisted as well which can cause a problem called hypovolemia due to the congestion of the blood caudal to the twist that can't get back to the heart. This can send the animal into shock. This is the first concern that must be resolved, because you do not send an animal into surgery that is in shock. I'm worred about the little cocker. Even with surgical management 25% of the cases don't make it. The picture below shows how the stomach twists on itself.



***** Final cocker update*** He didn't have to go to surgery. The doctor was able to decompress his stomach with a gastric tube, and he we home on Monday 2/23!

Cocker Update

The little cocker spaniel didn't get to go home yesterday. He became febrile, began vomiting, and delveloped a very distended abdomen. An IV catheter is being placed right now.

First week of clinics

This week has been so crazy. The class of 2010 started clinical rotations on Monday, and we are in full swing. I'm on radiology first, so I'm taking a bunch of radiographs. I watched a fluoroscopy on Tuesday; the dog had urethritis. I've seen a bunch of awesome cases. One of them is a cocker spaniel I actually just saw on Sunday at the emergency clinic that I work for. The dog came in on Saturday straining to urinate, and when he did manage to urinate it was bloody. We did a urinalysis and the blood spun down to a pellet, cbc and chem panel was WNL. Abdominal radiographs were also completed in order to rule urinary calculi.

This is not the cocker's radiographs, but this is an extreme case of bladder stones. We thought we might see one or two small ones, but we saw nothing.

When I came in Sunday morning, the urine was still bloody, but not quite as dark and it actually cleared up thruoughout the day. Around 5pm the urine was again very dark brown.
(urine is on the left: suggestive of hemoglobinuria or myoglobinuria, serum is on the right, the red color is expected with to correlate with hemoglobinuria)

We again centrifuged the urine, but this time the color did not spin out, and a RBC pellet was again found at the bottom of the tube. This led us to think perhaps this cocker spaniel was experiencing hemoglobinuria or myoglobinuria. In order to test for this we then drew blood and spun it down and also began to run the CBC and chem panel. If it was hemoglobinuria we would expect the serum to be pink (b/c of hemolysis) and the hemoglobin levels to be low. If it were myoglobinuria we would expect the serum to be clear, and hemoglobin levels to be WNL. Creatinine Kinase would also indicate myglobin release, but our lab at the emergency hospital doesn't test for this enzyme. So the results.... Hemoglobin is LOW! but the serum is clear!! very weird. So next I drew more blood to do a slide agglutination test which tests for IMHA (immune mediated hemolytic anemia), and it looked like this....

The red blood cells have clumped together, suggesting that they have antibodies on them that are recruting more and more cells to come attack the red blood cell causing them all to stick together.... this cockers blood did this... again... how does it fit in!? This dog did not have pink serum which goes hand in hand with IMHA, nor was the dog anemic. Actually- I take that back. I did a PCV 3 times on this dog. I got two different PCV readings from the SAME TUBE OF BLOOD: one was 45, one was 30. Then the machine told me the PCV was 25.

So anway- I left Sunday night in a bit of a confusion. As I was trying to fall asleep Sunday night I kept thinking about this dog. I got up to read all my notes to see if I could put the puzzle together, but I just couldn't make it work. I couldn't sleep very well that night, which was unfortunate since I was to begin clincis at 8am the next morning. (I was so sad to think that I may not see this case reach resolution.

On Wednesday guess who came to LSU-SVM?! That's right!! That cocker spaniel!! He came to radiology for thoracic radiographs to rule out metastatic dz that may indcate some primary tumor that was ill-defined on abdominal radiographs. He also went to ultrasound. This is where it got good. The gall bladder was HUGE! Larger than the kidney. It also had a mucocele in it!!

The spiney projections are the mucocele. (none of these pictures are from this case, just examples)

There was also a clot in the urinary bladder, not a true mass, just a clot. The dog went to surgery today.They removed the gall bladder, and took a biopsy of the urinary bladder They also took a biopsy of the stomach wall, and small intestine too becasue there was a medium size area of inflammation in the area of the duodenum. I can't wait to see what comes back!!

Pet Therapy at Our Lady of the Lake Hospital

Tuesday night I went with a group from my school, CVF (Christian Veterinary Fellowship) to Our Lady of the Lake Hospital and joined with a pet therapy team to help cheer up pediatric patients. Only 3 of the 90 children were able to see the pets, but we were allowed to visit with many of the others and give them Valentines Day goodie bags. It was so great to see how happy the dogs made them. Two of them had dogs of their own at home, so they were especially happy to see a furry friend. We met a lot of patients that night, and I am still praying for each one of them. It breaks my heart to see kids sick, but I'm happy to see they are getting such excellent care. One little boy, Jonathan, is a St. Judes leukemia patient. He was at OLOL to receive a blood transfusion. He told me about his Make-A-Wish. In May, he will be joining Kenney Chesney on stage to sing a song. I can't remember the song. I asked him to tell Kenny Chesney "hello" for me. :) We got to help tell a little girl, Terrace, goodbye to OLOL- she was leaving that night! She was excited for a good meal. I don't think I was as comfortable in that setting as I would have liked to be, but it was only my first time. It's hard to see kids sick. I'll work on it for next time, if there is a next time. I hope we get to go back.

2.5- done! next is 3.0

I picked up the slack all right!

and it's offcial... I'm for sure doing the race. I registered last week and my bib came in the mail today.

Crescent City Classic

Did I mention that I'm training for a 10k? That's 6.2 miles. I've only ever mastered 1 mile. After that my brain says "No more!" But... Now 1.5 miles seems like nothing and I'm going to push myself to do 2.5 miles. I'm dressed and ready for my run now, but I just ate an orange and I'm going to let it settle for a bit. I was actually supposed to do 2.5 last week, but because of open house and the coating ceremony and with my family coming in - I actually skipped 2 days last week. It just happened that they were both the 2.5 days. So.... I'm going to pick up slack today... maybe :)

Shelly is actually going to come run it with me. All the way from Honduras! She will be coming in for interviews, so this will be just a bonus! Did I mention that it's also in New Orleans? I'm excited about that. I really like New Orleans. Maybe we'll go get some beignets when we cross the finish line!

White Coat Ceremony!!

My mom and grandparents came down on Friday afternoon, just in time to get ready and then head to the school for the coating ceremony. I found my seat and waited. I couldn't believe it was actually happening. I have waited for this for so long, and even though I've been in Baton Rouge for over 2.5 years, it felt like it came up so quickly. I wanted to remember everything. Dr. Taboada welcomed everyone there, and even commented on how our "family" has grown since the blue coat ceremony at the start of first year. This time... there was standing room only. He quickly cut to the chase and started calling names. I had an aisle seat, so that meant I was to lead the others behind me when it was our turn to go. Since I was on the opposite side of the auditorium from where we would enter the stage, we had to walk to the back of the auditorium and back down again. I saw 2 of my friends husbands as I was walking... but only because they called my name. I don't think I would have seen anyone's face if they had not brought themselves to my attention... I was focused on one thing only... stage... coat.... put it on without getting tangled up! Luckily everything went smoothly, I didn't get caught up in the sleeves or anything, and I even paused on stage so Josh could get a picture.













I almost missed it becuase I didn't see him standing up! Afterwards, we all congratulated each other out in the hallway then zipped off to dinner with the Smith's at Sammy's. Mom presented Stacey and I with cute festive gifts and "congrats" balloons!! She got us both super cute lunch boxes for clinics.
The next morning was open house. This is the best time to come visit the school of veterinary medicine, becasue all the coolest and newest technologies are out on display! Papa was very interested in all of the hands on things. He even got to put his hand inside a cow's rumen! Josh did too, which really surprised me, because things like this usually gross him out. There was no blood involved, but the smell of rumen contents is not very delightful. He was a good sport and did it though! He also got to palpate a set of goat lungs. They were set up on a machine that would demonstrate inspiration and respiration.