More good news....

This job is never dull. Last week I saw a wonderful, friendly standard poodle. He was 1.5 years old and had (sorry to gross you out) diarrhea for over a week that would not resolve with symptomatic treatment. Dogs very frequently eat or drink something they're not used to and develop a dietary indiscretion, or "garbage'gut." They develop diarrhea and some vomit, but this usually resolves with symptomatic therapy. Not this dog....
Finally, I did a rectal exam on him. Put a finger in his bum and "holy s--t!" he's got a huge mass growing in his bum that felt like it was very firmly attached to his pelvis. This guy is way too young for cancer, I thought to myself..... I sighed deeply and explained to his owner what I had found. She was devastated. I told her not to worry, at which she scoffed. I referred her to an internist (yes, this happens frequently) for further diagnostics including a biopsy of the mass.

Not the same mass as that found in the dog's behind.


The dog had a CT scan revealing a very large mass that likely involved the dog's pelvis - already bad news. Biopsy results were pending.....

Briefly having forgotten about this dog for a day or so, I received a copy of the internist's report, including the biopsy report.
"WHOA!" I yelled out loud. I was ecstatic. The firm mass was not neoplastic (cancerous) but rather INFECTIOUS! In the biopsy they found club-shaped bacteria consistent with an infection called Nocardia or Actinomyces. We learn about these things in school but they are relatively quite rare. The bottom line is that this is most likely curative. The dog does not have cancer and will survive. The dog is on a penicillin and trimethoprim-sulfa, two types of antibiotics that should eradicate this infection.
These types of bacteria are usually associated with a penetrating foreign-body (a splinter, for example) in the skin. Perhaps a foreign body penetrated into the wall of this guy's rectum - ouch.


Nocardia bacteria (image to right)

Actinomyces bacteria (image below), similar to Nocardia.....













We are all surprised at the diagnosis and happy with the outcome. This appears to be the theme of the last few posts, eh?

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Fatty tumor...

A very big, wonderful, friendly, black lab had a very large mass involving the dog's entire left forearm. It was painless and did not cause a limp. This dog's tail never ceased from wagging.
The dog was seen by a veterinary oncologist who had recommended a biopsy of this mass. That's when they came to see me.
I followed the internist's recommendations and when I went to biopsy the mass, a very large amt of fat popped out of the incision (kinda gross but really interesting as there is typically no fat in this area!). Continued dissection in between the muscles of the forearm allowed me to remove a large, single fatty mass, likely what's called a lipoma (I still sent out a "chunk" of this mass to the pathologist to confirm the diagnosis. It looked exactly like a raw chicken breast or a silicone fake booby when laid out on the table. The location of this lipoma is highly unusual!
My technician and I were completely pumped. We took a digital photo during surgery which I will likely upload in the next few days. Today is two days post-op and the dog is doing great.
What's really interesting is that previously a fine needle aspirate (when you suck cells out and spread them on a slide - with a syringe and not your mouth....) was done. The results of this aspirate revealed a much more dangerous tumor than that which I removed from the dog. These results did not correlate at all, underscoring the need for "chunk" biopsy of the actual tumor.
We are all delighted with the findings and the dog's recovery!

Fake boobies - not tumors.

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Vart

I've combined the words 'art' and 'vet' which make up the word 'vart.' I will devote this entry to selfishly post some of my artwork. I am passionate about playing with myse... err, I mean art as much as I am passionate about veterinary medicine. Enjoy the vartwork. I'll be posting more in the future whose subject is other than fruit.

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Back in TO

An eleven-hour day Monday after a week off was, er, umm, difficult to say the least. Though, it was enjoyable. Neutered a large dog (with large nuts) and had a routine dentistry to do as well. Dogs and cats need to be under general anesthesia in order to properly scale and polish their teeth, and also to determine the extent, if any, of periodontal disease. Just like a dentist would perform on a person, so would we probe our patients' mouths, take intra-oral radiographs (x-rays), extract teeth, and even do root canals, called endodontics (endo-, for inside the tooth). I, personally, don't do root canals but our local referral practice can certainly take over those cases.
I saw a dog for a swelling of the lower jaw. A year before I saw him he had a similar episode of lower-jaw swelling and was treated for an allergic reaction. I examined his teeth and one of his lower canines was discoloured. A radiograph of the tooth revealed it was completely devitalized - dead! I took the tooth out and the dog's swelling will never recur (at least not due to that tooth).
This case is not to toot my horn, but rather to show that any odd swelling, abscess, draining tract (fistula), etc., on or near the dog's/cat's head must be accompanied by a thorough examination, including radiographs, of the patient's mouth and teeth.

This is a dog under general anesthesia getting his/her teeth scaled and polished. Note the mysterious gloved individual signing his/her name in the dog's mouth. This is usually avoided.

Below: the darker areas around the roots of the larger tooth are abscesses. This tooth needs to come out. The crown, or portion of the tooth above the gumline, may be visually normal and yet have roots that radiographically look like shit.

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Feeling sick in Scottsdale

I feel like I was hit by a milk truck. Or maybe one of the billions of SUVs (see previous entry and accompanying photo) in Scottsdale. I attended a (way-too-difficult-for-me) Yoga class the night before last. Sore yesterday. Sore today. Of course, still worth it.
Nothing veterinary-related to discuss today as I just don't have the strength to do so.


Photo showing the smallest car I've seen in Arizona.

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Thinking too much....

I'm trying to sit still and relax but a combination of genetics and good coffee precludes any capacity for me to do so.
There was a case of a cat with fatty liver disease that I saw a good four months ago or so. Fatty liver disease is a feline disease (more often obese cats that have rapidly lost weight) in which the liver essentially becomes 'pate de foie gras.' It may or may not be associated with a primary disease such as inflammatory bowel disease, pancreatitis, etc. The cure: calories - the cat must be fed. Often harder in practice. The cat was clinically ok besides being the same colour as Tony the Tiger. I thought for sure I'd cure him. After the placement of his feeding tube (an esophageal tube, placed in the lateral neck area directly through the skin and extending to just before entering the stomach) he did well for a few weeks then crashed and died at the local emergency clinic. I feel tremendously guilty.
Radiographs after the tube placement showed very good positioning. Was it the tube? Did the cat have a more serious primary illness? Theoretically, that's usually the case, however in real life vets often will not find a concurrent illness besides the "idiopathic hepatic lipidosis." For those who've never heard the word 'idiopathic,' it's a fancy word describing an illness for which a cause or etiology cannot be found. Very often, there is some stress in the history. For example, a change of environment: new house, addition of a baby, death of another pet, etc., etc.


These cases weigh heavily on me. The pet owners trust that I am doing the right thing and though many cases end happily, others do not. Thus is the world of (veterinary) medicine. Months down the road I still feel a sting of regret while telling myself, "What could I have done to prevent that outcome?"
For everyone who knows me, I am a harsh self-critic.......

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