Serious cases bring rough week at veterinary hospital
It has been a rough week, followed by a rough Saturday and I am taking a shift at the ER tomorrow.
It’s not that anyone working at a veterinary hospital expects everything to be all puppies and kittens, we do not, but sometimes a case or a few will get to me.
It is unusual for me to not love my job, so I found myself looking to see what was different on this Saturday afternoon. I think it is a combination of four things.
This week has been filled with frustrating cases.
I am not arrogant enough to think that every case I touch has to do well. Some things are beyond my control. But I do like to know what’s going on, why it is happening and the odds of my treatment fixing the problem. I study and learn and remember to be able to do this capably every case.
The past two weeks have had more than their share of serious diseases without a name. We have had five or six cases in isolation with a weird bacterial infection. I know it is a bacterial infection because the white blood cell count is very high and the type of white blood cell that is elevating it is the neutrophil.
Neutrophils come in to play with bacterial infections. So, Molly, Rusty, Pup, Lucy, Mule, Sunshine and Squeeky all had bacterial infections recently. Some were prostates, skin, teeth abscesses and routine stuff, but some were life threateningly high infections with no definite site of infection. These had tests to tell me what they were not, but not what they were.
One of these was a puppy out of a litter. Although many owners would make the economic decision not to treat, they wanted to save the pup even if it could not be sold. I get how we make non-economic decisions about our pets every day, but it meant a lot that they wanted the pup treated “right” with “whatever it needed.”
They really did mean it, too. Unfortunately, even with tests, IV fluids and IV care, the pup died this week. It had briefly improved and I got my hopes up, but ultimately it was not to be. I don’t like when they look better only to decline.
Another frustration was a praying mantis that molted during shipment. The container was too small and the mantis arrived deformed and struggling. I worked with magnification to remove the shed that was stuck, but the new exoskeleton was already hardened into the deformed shape. I have tried hand feeding, dextrose and fluids without any success. I am a tad surprised how much I can care for a mantis.
There are the continued little stresses. The grain-free diet discussions continue to frustrate me. Again, in the exam room this morning, I was explaining how grain-free diets are causing hypertrophic cardiomyopathy and death. The client after listening (I thought) said he would change to a more expensive (but worse) grain free diet.
No. Just no.
And then CeCe came in today. CeCe was a rescue from a breeding operation. The owners had her for less than 24 hours. She was covered in feces when they got her, but they didn’t know that until they had paid for her. She was so sick, it was unclear what was going on until we had blood work, tests and radiographs (x-rays). While getting blood work, bloody, nasty diarrhea ran out. Radiographs showed thickened, angry intestines.
In contrast to every other case this week (not really, but it seemed that way), CeCe’s primary problem was not a bacterial infection.
Her white blood cell count was low. Very low. CeCe had a viral infection. The parvo test was a faint positive.
Since she was given a poor-quality vaccine, it could have been the vaccine causing the positive response and it could have been an active case of parvo.
This parvo was complicated by HGE or hemorrhagic-gastro-enteritis. HGE is a combination of a bacteria, a virus and a stress response. It is characterized by a high red blood cell count. A hematocrit is roughly a percent of red blood cells in the system. Anything over 60 percent is likely HGE. CeCe’s was 73.6 percent!
When the red blood cells are over 65 percent of the total, the blood starts to sludge in the system. That means it cannot carry oxygen to the tissues. Indeed, the blood that I collected was very dark, like a dark, stout coffee color.
(Great! Two life threatening diseases at one time in a really, really sick dog!)
CeCe’s parents were overwhelmed. They didn’t say anything about the “rescue,” but we certainly thought it was unfair. Treatment was too much. Even with a heavy discount because of their situation, they did not want to treat.
And, truthfully, we could understand, but we couldn’t accept it from CeCe’s point of view. We got permission to treat and adopt out, but even before we could start IV fluids and antibiotics, CeCe died.
So, I am headed to the ER after a week of cases that didn’t follow the rules, cases that could not be helped, thinking of a new way to cut through the grain free myths and with the unfairness of CeCe weighing on me.
Oh, and M’Kinzy headed back to college as a junior!
It has been a rough week and it is not over, yet.
MJ Wixsom, DVM MS is a best-selling Amazon author who practices at Guardian Animal Medical Center in Flatwoods, Ky. GuardianAnimal.com 606-928-6566