Inspissated

Today I wrote a necropsy report using the word "inspissated." It's a word that I didn't even know existed before vet school. But I have a job where using cool words like that is a regular occurrence.

The necropsy/autopsy is a very old medical tool. There are some fairly strict rules for how to go about it, and it would be easy to dismiss these rules as a bit old fashioned. Our understanding of the pathology of disease at the molecular level has exploded in the past few decades. But here we are, still examining animal remains with our eyes and fingers (and noses--I've made some interesting diagnoses based on characteristic odors). And while in plenty of cases I will request additional diagnostics such as PCR (polymerase chain reaction) for a specific virus--a tool that was only developed in the early 1980s--I can often reach a conclusion in my necropsy cases based only on gross findings (in this case, gross means obtained by visual examination).

So in no particular order, here are some of my recent cases which required no additional testing:

• heat prostration in dogs (5 cases in September alone)
• a dog whose chest was pierced by small caliber bullet or sharp object (nicked a large vessel, dog died of shock due to loss of blood, although the lungs were also collapsed which probably didn't help this pup); I found the 2mm entry wound because I always do a complete physical examination of the exterior of my cases before I begin the necropsy, and I was able to follow the damaged tissue trail into the chest
• pyometra (bacterial infection in the uterus) in an unspayed female pitbull (backyard breeder)
• chronic, severe footpad dermatitis in some commercial broiler breeder hens and roosters (the pus in the abscesses in their feet became inspissated)
• a dog whose chest and abdomen were filled with blood due to a very large, ruptured hemangiosarcoma on its spleen (dog also died of shock due to sudden loss of blood; I estimated the volume of blood inside its abdomen alone to be 3 L, which was over half the blood in its body)
• a middle-aged male Boxer with progressive neurological signs--when the case came in, I predicted a mass in its brain and I was right: it was an aggressive oligodendroglioma (Boxers are considered textbook models for brain tumors)
• two backyard laying hens (different owners) with astonishingly advanced ovarian/oviductal carcinoma
• a goat with anemia that had horrible intestinal parasites--anemic small ruminants have Haemonchus in their abomasums (one of the forestomach compartments) until proven otherwise, and there was no proving otherwise in this case
• a dog that died suddenly--it had so many whipworms in its cecum that I called it a "Trichuris burrito"--whipworms are common intestinal parasites but are easily controlled with modern parasiticide products which this dog had not received
• a cat with a SINGLE heartworm in its right atrium and horrific heart disease (one heartworm is enough to kill a cat)
• a calf that had been banded improperly so that the testicles were pushed back inside and an infection developed at the site where the band was placed; the band and empty scrotum fell off but the infection ascended into the abdomen, and ultimately the calf died of bacterial sepsis (I only figured this out when I found the infected testicles inside his abdomen; all evidence of the scrotal sac and band were gone; it was a bit of an awkward moment when I called the producer and asked, "Um, did you castrate this animal? Because I found both testes inside it..."

All of these cases were from the past 5-6 weeks, and they are a fraction of my actual case load. Since I started in July, I have performed 89 solo necropsies. That's actually more than 89 individual animals since the commercial poultry producers usually submit between 10 and 30 birds.

I always try to approach a case with some differentials in mind, and I do this to help focus my attention on particular organs or tissues. Before I do the necropsy, I read the submission form and whatever history I am provided. I might call the producer or referring veterinarian to get more history. I often look at papers or pull a textbook off the shelf and skim a chapter or two. And when I perform the necropsy, I follow the old fashioned rules--be thorough, be systematic. Look at everything. You might decide it is normal but you still need to look at it.

Sometimes following the old fashioned rules are all you need to close a case.