I've been struggling lately to find blog-worthy topics. I absolutely love my job. I look forward to getting into the lab every day. There's no way to predict what will walk in the door! Unfortunately, most of the stories that I can spin these days, based on events at work that I find interesting or amusing, are inappropriate for public retelling. And I don't think that I want to turn this blog into "Tales From The Necropsy Floor." Even most veterinarians don't want to see endless photos of diseased tissues in dead animals.
As an example of a story that isn't suitable for public consumption, consider the rabbit we received last week. Most of the small animal submissions we receive are wrapped in bags or tarps then placed in a cooler or box or some other opaque container. The rabbit arrived in a small cardboard box, taped up for shipping. The necropsy techs were at lunch so I told Receiving I'd carry the remains back to necropsy. I opened the box to look for the paperwork...and found the submission form folded up and laid on top of the rabbit. No other packaging, not even a WalMart bag. Just the dead rabbit and a folded up piece of paper in an otherwise empty cardboard box. There are several layers of subtext as to why this was funny...but I don't think I can spin any of them into an acceptable party tale.
Here's another example. My interest in laying hens and ovarian/oviductal cancer is underlain by a deeper interest in reproduction. I now have access to many different species of animal, and I've begun building a library of fixed tissues and slides of reproductive tissues, both with disease and without. We recently received a male sugar glider for necropsy. I did some research and learned that, like most marsupials, sugar gliders have some freaky ass reproductive organs. I walked in to necropsy, pulling on the heavy gloves we wear and snapping them in place just like they do on the TV, and announced to my two techs, "Sugar gliders have a forked penis. I'm adding this one to my collection." They just laughed. Yes, I am perfectly aware that writing it out like this makes me sound like a psychopath. But I've explained to them my interest in reproduction and my desire to understand both the gross and the microscopic appearance of reproductive tissues of all kinds of animals. So I deliberately collect those tissues even if they don't have anything to do with the cause of death of the animal. This is another aspect of my job that I can't discuss outside of work.
Here's a third example. Besides animal remains for necropsy, we also get surgical biopsies submitted by veterinarians located all over the state. These are lumps and bumps and masses that they remove from their patients and send to us so we can make slides and have a pathologist look at them to make a diagnosis. The basic process is for the submitting veterinarian to place the tissue in formalin. This chemical causes proteins in the tissue to become cross-linked so the tissue becomes stiff and sort of rubbery. We then cut thin pieces from the tissue, embed that in paraffin wax, then cut even thinner slices of that and mount it on a glass microscope slide. The tissue is stained, a cover slip is glued on, and then the pathologist gets that slide for interpretation.
When I took over supervisory duties for the Pathology section, I instituted several new QC processes, especially for the surgical biopsy submissions. There had been none in place before--apparently it was left up to the techs to decide how to cut up the submitted tissues. They would often slice up tumors in ways that suited them, but that did not produce diagnostic samples or slides. I now examine every biopsy submission and give the techs written instructions for key areas to focus on. Sometimes I give instructions to leave submissions in formalin for another 24-48 hours, or note that the sample is extremely fatty and needs to be placed in a different fixative.
Last week, we received a tissue sample from a young Great Dane bitch. It was an external "mass" that was growing adjacent to the vulva of the dog. The vet excised it and sent it to us in a pill bottle. Not a good choice--pill bottles leak, and formalin is hazardous. They didn't put enough formalin in the bottle and most of the tissue sample was uncovered. Suspecting that it wasn't adequately fixed, I pulled it out to take a look and promptly bonked my forehead on the glass door of the fume hood as I yelped "My god, it's an alien baby!" The tissue was so complex and so confusing that I immediately called the submitting veterinarian to find out more. Turns out she was just as perplexed as I was, and was hoping that we would tell her what it was. I tweaked her a bit for sending the damned thing in a leaking pill bottle, which she took with good grace.
I drew a picture of the alien baby with trimming instructions for the techs. Then I sent a wordy email to the pathologist I was sending the slides to so he would have some context about why I was sending him 10 slides for a single biopsy submission (most only require a single slide). I described the alien baby in great detail. He replied with a mock histopathology report with phrases like "mixture of reptilian and insectoid features." It was hysterical. And I'll never be able to tell this story in public.
Friday, November 29, 2019
Thursday, October 31, 2019
Trained For This
Our small animal necropsy submissions usually arrive at the lab in coolers or cardboard boxes. This means that the folks in Receiving don't deal with actual animal remains, only with containers.
When I walked into the Receiving area after I returned from lunch on Tuesday, I found our bacteriology supervisor standing there paralyzed in place with eyes the size of dinner plates. We've had some staff turnover in Receiving, and she was covering the phones for the lunch hour. There was a young couple, who looked to be in their mid- to late twenties, both crying. The guy was holding a dead cat in his arms. No box or bags in sight. To be fair, he had a towel but he was holding the kitten on it as if it was lying in state. The bacteriology supervisor was in no way going to touch the dead cat. Clearly the submission part of the process had ground to a halt.
I immediately thought, hey, I've been trained for this. I went to school for four years to learn about things like this. I think I can help out here. I set my things down, and told the bacteriology supervisor that everything was okay. I went over to the couple and talked with them for several minutes. Their kitten had died suddenly after a night of seizures. They were terrified it was because he ate a plant from their yard, or got into some household cleaner or poison. They had several baggies with samples of all of the suspected items--seeds, a mothball, leaves. I asked them questions about what they wanted us to help them with, and I helped them understand what a necropsy could and could not do (it's not magic, in short). I told them that Amy would help them finish the paperwork. Then I gently took the kitten in my arms, and asked them if they were sure they had said goodbye to their beloved pet. They started sobbing while petting him for the last time. The bacteriology supervisor started sobbing. I was tearing up too. I carried kitten back to the necropsy floor, startling my tech when I came in carrying a dead cat in my arms along with a handful of baggies full of plants. I set him down on the table and told her, it's all okay, I will change into scrubs and be right back.
Besides this poor kitten, I've had a couple of really emotionally challenging cases recently, and decided to call a classmate that night to blow off some steam. She is a GP in a small animal clinic in Oregon. She loves her job, and some clients are even starting to request her as the doctor they want to see. We talked about the millions of different ways that compassion is a part of our daily work. Dark humor is never far away, always bubbling along, but it is more than offset by the moments when we are totally in the moment with our clients and patients.
When I walked into the Receiving area after I returned from lunch on Tuesday, I found our bacteriology supervisor standing there paralyzed in place with eyes the size of dinner plates. We've had some staff turnover in Receiving, and she was covering the phones for the lunch hour. There was a young couple, who looked to be in their mid- to late twenties, both crying. The guy was holding a dead cat in his arms. No box or bags in sight. To be fair, he had a towel but he was holding the kitten on it as if it was lying in state. The bacteriology supervisor was in no way going to touch the dead cat. Clearly the submission part of the process had ground to a halt.
I immediately thought, hey, I've been trained for this. I went to school for four years to learn about things like this. I think I can help out here. I set my things down, and told the bacteriology supervisor that everything was okay. I went over to the couple and talked with them for several minutes. Their kitten had died suddenly after a night of seizures. They were terrified it was because he ate a plant from their yard, or got into some household cleaner or poison. They had several baggies with samples of all of the suspected items--seeds, a mothball, leaves. I asked them questions about what they wanted us to help them with, and I helped them understand what a necropsy could and could not do (it's not magic, in short). I told them that Amy would help them finish the paperwork. Then I gently took the kitten in my arms, and asked them if they were sure they had said goodbye to their beloved pet. They started sobbing while petting him for the last time. The bacteriology supervisor started sobbing. I was tearing up too. I carried kitten back to the necropsy floor, startling my tech when I came in carrying a dead cat in my arms along with a handful of baggies full of plants. I set him down on the table and told her, it's all okay, I will change into scrubs and be right back.
Besides this poor kitten, I've had a couple of really emotionally challenging cases recently, and decided to call a classmate that night to blow off some steam. She is a GP in a small animal clinic in Oregon. She loves her job, and some clients are even starting to request her as the doctor they want to see. We talked about the millions of different ways that compassion is a part of our daily work. Dark humor is never far away, always bubbling along, but it is more than offset by the moments when we are totally in the moment with our clients and patients.
Monday, September 30, 2019
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:
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.
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..."
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.
Saturday, September 07, 2019
Just Look At This Dude!
Look at this bug trying to pass himself off as some dried up pine needles hanging off the wires. He's been there all day.
Inappropriate
Taken out of context, nearly every conversation that I have at work makes me sound like a psychopath or totally unhinged. Either way, when added to the general funk that hangs about my person on most necropsy days, I am now mostly unfit for normal adult society.
During our first night in Archie's agility class, I was asked by the teenaged daughter of one of the women if I saw mostly dogs. She thought I was a small animal clinician. I told her, "Oh, no, I work with all species, as long as they are dead." Which in the nanosecond between thought and words leaving my mouth seemed like a funny joke. In reality, neither the girl nor her mother spoke to me again that night. (I've since mended things with the mother.)
The director of the lab mentioned the fancy photography table out on the necropsy floor. He wanted to know if I wanted to use it. I told him, "I have indeed been stepping up our game on photographs but I've been having quite a bit of success with rinsing the tissues and posing them on a clean cutting board." And he just nodded like this was a normal thing to say.
A woman brought in a gecko for a necropsy around 3pm on Friday. That's kind of late in the day--everyone is thinking about heading home, what they will make for dinner, what they will be doing for the weekend. But in my limited experience with reptiles and amphibians, I know they autolyse extremely quickly. The gecko would have melted into a puddle of gecko goo if I left it until Monday. So I grabbed it from Receiving and went skipping down to necropsy to get set up. One of the lab techs from bacteriology saw me and said, "Wow, so much energy for Friday afternoon." And I replied with considerable enthusiasm while brandishing the small, already rather smelly box at her, "I get to necropsy this gecko!" She nodded slowly, eyes widening, and said, "Oh" while walking away more quickly than necessary.
I've had considerable success at arriving at some sort of diagnosis for most of my cases to date. But I had a case with a cat last week that completely stumped me. The director asked me about my conclusions for the cat, and I said, "Well, the only problem I could find is that she's dead." He's starting to get used to me, but that reply even stopped him for a couple of seconds.
To a much greater degree than most human medicine practitioners (with the exception of certain specialists), veterinarians directly confront death on a daily basis. Compassion fatigue is a very real problem in vet med. Suicide rates for veterinarians exceed those of human medicine doctors. Clinicians have to euthanize animals every single day. Every. Single. Day. In a busy emergency clinic, they will be performing several euthanasias per day. They have to deal with grieving owners, who may be in shock, may be enraged, may be distraught with grief. It's a heavy burden. Finding the middle path between becoming emotionally upset yourself and not having any emotional reaction at all is very hard.
I am somewhat shielded from that. I do not have to euthanize animals, but I do deal with upset and grieving owners and with upset and grieving fellow veterinarians who had to euthanize the animal they are submitting to the lab. And my own job is to then perform very invasive actions on the remains of the animals. It is always jarring to me to see someone's beloved pet lying on the metal table, still with an IV catheter in place covered with vet wrap.
The way I deal with my personal emotions is to take a couple of minutes and carefully examine the exterior of every animal. I run my hands over every inch of them. Of course that is just good pathology practice, but it also gives me time to think about the life each animal had. Was it cared for? Was it loved? It's a way for me to honor that animal, and thank them for letting us try to learn what happened to them. Nobody I work with knows that I do this.
My inappropriate comments are a release valve that let me blow off emotional steam. But they are not intentionally disrespectful. Vet school is so immersive that it is hard to remember that the black humor so common in our profession is usually not appropriate outside of those settings. Now that I'm out in the real world more often, it's hard to be mindful of how others perceive my job.
During our first night in Archie's agility class, I was asked by the teenaged daughter of one of the women if I saw mostly dogs. She thought I was a small animal clinician. I told her, "Oh, no, I work with all species, as long as they are dead." Which in the nanosecond between thought and words leaving my mouth seemed like a funny joke. In reality, neither the girl nor her mother spoke to me again that night. (I've since mended things with the mother.)
The director of the lab mentioned the fancy photography table out on the necropsy floor. He wanted to know if I wanted to use it. I told him, "I have indeed been stepping up our game on photographs but I've been having quite a bit of success with rinsing the tissues and posing them on a clean cutting board." And he just nodded like this was a normal thing to say.
A woman brought in a gecko for a necropsy around 3pm on Friday. That's kind of late in the day--everyone is thinking about heading home, what they will make for dinner, what they will be doing for the weekend. But in my limited experience with reptiles and amphibians, I know they autolyse extremely quickly. The gecko would have melted into a puddle of gecko goo if I left it until Monday. So I grabbed it from Receiving and went skipping down to necropsy to get set up. One of the lab techs from bacteriology saw me and said, "Wow, so much energy for Friday afternoon." And I replied with considerable enthusiasm while brandishing the small, already rather smelly box at her, "I get to necropsy this gecko!" She nodded slowly, eyes widening, and said, "Oh" while walking away more quickly than necessary.
I've had considerable success at arriving at some sort of diagnosis for most of my cases to date. But I had a case with a cat last week that completely stumped me. The director asked me about my conclusions for the cat, and I said, "Well, the only problem I could find is that she's dead." He's starting to get used to me, but that reply even stopped him for a couple of seconds.
To a much greater degree than most human medicine practitioners (with the exception of certain specialists), veterinarians directly confront death on a daily basis. Compassion fatigue is a very real problem in vet med. Suicide rates for veterinarians exceed those of human medicine doctors. Clinicians have to euthanize animals every single day. Every. Single. Day. In a busy emergency clinic, they will be performing several euthanasias per day. They have to deal with grieving owners, who may be in shock, may be enraged, may be distraught with grief. It's a heavy burden. Finding the middle path between becoming emotionally upset yourself and not having any emotional reaction at all is very hard.
I am somewhat shielded from that. I do not have to euthanize animals, but I do deal with upset and grieving owners and with upset and grieving fellow veterinarians who had to euthanize the animal they are submitting to the lab. And my own job is to then perform very invasive actions on the remains of the animals. It is always jarring to me to see someone's beloved pet lying on the metal table, still with an IV catheter in place covered with vet wrap.
The way I deal with my personal emotions is to take a couple of minutes and carefully examine the exterior of every animal. I run my hands over every inch of them. Of course that is just good pathology practice, but it also gives me time to think about the life each animal had. Was it cared for? Was it loved? It's a way for me to honor that animal, and thank them for letting us try to learn what happened to them. Nobody I work with knows that I do this.
My inappropriate comments are a release valve that let me blow off emotional steam. But they are not intentionally disrespectful. Vet school is so immersive that it is hard to remember that the black humor so common in our profession is usually not appropriate outside of those settings. Now that I'm out in the real world more often, it's hard to be mindful of how others perceive my job.
Tuesday, August 27, 2019
The New Vet in The New Job
I'm settling in to the new job. I've had to make some mental adjustments--I still feel a twinge of anxiety when I leave at 5pm, after everyone else already left at 4:30pm. Vet school leaves deep scars, that's for sure.
I have had a string of very interesting cases these past few weeks and have really been knocking out some cool diagnoses based only on what I see in the animal remains--which are later confirmed with ancillary tests or by looking at microscopic slides of tissue. I think it's a combination of beginner's luck and a fairly decent vet med foundation.
There is a rule of thumb in vet med that goes like this: "don't go looking for zebras." I've also heard it expressed as "common diseases present uncommonly." In other words, if you see strange things, you shouldn't be thinking strange problems, although those are always possible. You should be thinking about common, garden-variety problems first.
Here are two good examples of this.
Case 1: intact female pit bull mix, 5 years old, history of vomiting, died suddenly. Before I even touched her, I took one look at the dog on the table and told my tech, "it's pyometra." Sure enough, there was more than 400 mL of brown, cloudy fluid in her left uterine horn. She died of sepsis as the bacteria and their toxins started leaking out into the rest of her body. It was not a good death. But it is a very common one for intact female dogs with this signalment and history. Her breed was one red flag. Her age was another. Five years old and still intact? Either a stray or a backyard breeder. A rescue org or a shelter would have spayed her. Sure, a foreign body or gastric volvulus (twisting) would have caused untreatable vomiting and death. And both were certainly on my list. But vets are trained to make a ranked list of differentials. And pyometra was at the very top of the list for this dog.
Case 2: neutered male Boxer, 5 years old, progressive neurological signs over period of 18 months that were not responding to anti-seizure meds. I told my colleague, "it's a brain tumor, probably a glioma." Sure enough, I found a huge gelatinous tumor in the left cerebral hemisphere, confirmed by a board-certified pathologist to be a malignant oligodendroglioma. Boxers are poster-children for gliomas. I also found changes in the valves and right side of this dog's heart that I carefully described in my report. The pathologist confirmed a right-sided cardiomyopathy of a kind that is very specific to Boxers. While in school, I learned about diseases that are more common in certain breeds of animal, and I went looking for those particular lesions. And found them, to my great satisfaction. This was a good case because it gave a lot of closure to both the referring veterinarian and the owners--there was nothing they could have done differently to change the course of disease or the outcome.
Cases 3 and 4: backyard laying hens, history of losing weight, died suddenly. Both submitted today from different owners. I told my tech, "it's either ovarian/oviductal carcinoma or it's yolk peritonitis. Equally likely." It was aggressive ovi carcinoma in both cases. In a surprise zebra finding, one of the birds had right-sided dilational cardiomyopathy and ascites. Didn't expect that, it's more common in broilers and even then you rarely see it in the U.S. But this hen had what I think is a metastatic tumor in her left ventricle, which appears to have caused upstream problems in the right side of her heart and so on and so forth. Histopathology on the heart nodule will confirm whether I'm just making shit up or whether I'm right.
Don't misinterpret these tales. This is not some game of pool where I'm calling 8-ball in the corner pocket. It is appropriate to think of differentials for any case before you begin the necropsy. You want to be prepared.
For example, whenever I am presented with an exotic animal (for example, I've worked on a snake, a bobcat, and a kangaroo), I research possible zoonoses before I even walk onto the necropsy floor. Zoonoses are diseases (or parasites) that humans can get from animals. We can get zoonoses from pet dogs and cats but there are some increased risks when you work with exotic animals. I want me and my support staff to be prepared with appropriate protective gear. I want to be able to specially identify samples if there could be a risk to other lab personnel.
As a newly minted veterinarian, it's validating to do a necropsy, find lesions, describe them, suggest some possible diagnoses, and have other tests confirm my analysis so definitively. Sure, I make mistakes. Sometimes I miss important lesions. Sometimes I don't collect the right samples. But I'm learning, and I'm gaining confidence in my ability to recognize when something is not normal. I may not always identify the disease process in detail, and I may not always properly rank what I see (abnormal doesn't mean important). But I'm getting exposed to a wide array of disease processes in lots of different species.
And I am slowly learning that I can leave work at 4:30pm and everything is just fine.
I have had a string of very interesting cases these past few weeks and have really been knocking out some cool diagnoses based only on what I see in the animal remains--which are later confirmed with ancillary tests or by looking at microscopic slides of tissue. I think it's a combination of beginner's luck and a fairly decent vet med foundation.
There is a rule of thumb in vet med that goes like this: "don't go looking for zebras." I've also heard it expressed as "common diseases present uncommonly." In other words, if you see strange things, you shouldn't be thinking strange problems, although those are always possible. You should be thinking about common, garden-variety problems first.
Here are two good examples of this.
Case 1: intact female pit bull mix, 5 years old, history of vomiting, died suddenly. Before I even touched her, I took one look at the dog on the table and told my tech, "it's pyometra." Sure enough, there was more than 400 mL of brown, cloudy fluid in her left uterine horn. She died of sepsis as the bacteria and their toxins started leaking out into the rest of her body. It was not a good death. But it is a very common one for intact female dogs with this signalment and history. Her breed was one red flag. Her age was another. Five years old and still intact? Either a stray or a backyard breeder. A rescue org or a shelter would have spayed her. Sure, a foreign body or gastric volvulus (twisting) would have caused untreatable vomiting and death. And both were certainly on my list. But vets are trained to make a ranked list of differentials. And pyometra was at the very top of the list for this dog.
Case 2: neutered male Boxer, 5 years old, progressive neurological signs over period of 18 months that were not responding to anti-seizure meds. I told my colleague, "it's a brain tumor, probably a glioma." Sure enough, I found a huge gelatinous tumor in the left cerebral hemisphere, confirmed by a board-certified pathologist to be a malignant oligodendroglioma. Boxers are poster-children for gliomas. I also found changes in the valves and right side of this dog's heart that I carefully described in my report. The pathologist confirmed a right-sided cardiomyopathy of a kind that is very specific to Boxers. While in school, I learned about diseases that are more common in certain breeds of animal, and I went looking for those particular lesions. And found them, to my great satisfaction. This was a good case because it gave a lot of closure to both the referring veterinarian and the owners--there was nothing they could have done differently to change the course of disease or the outcome.
Cases 3 and 4: backyard laying hens, history of losing weight, died suddenly. Both submitted today from different owners. I told my tech, "it's either ovarian/oviductal carcinoma or it's yolk peritonitis. Equally likely." It was aggressive ovi carcinoma in both cases. In a surprise zebra finding, one of the birds had right-sided dilational cardiomyopathy and ascites. Didn't expect that, it's more common in broilers and even then you rarely see it in the U.S. But this hen had what I think is a metastatic tumor in her left ventricle, which appears to have caused upstream problems in the right side of her heart and so on and so forth. Histopathology on the heart nodule will confirm whether I'm just making shit up or whether I'm right.
Don't misinterpret these tales. This is not some game of pool where I'm calling 8-ball in the corner pocket. It is appropriate to think of differentials for any case before you begin the necropsy. You want to be prepared.
For example, whenever I am presented with an exotic animal (for example, I've worked on a snake, a bobcat, and a kangaroo), I research possible zoonoses before I even walk onto the necropsy floor. Zoonoses are diseases (or parasites) that humans can get from animals. We can get zoonoses from pet dogs and cats but there are some increased risks when you work with exotic animals. I want me and my support staff to be prepared with appropriate protective gear. I want to be able to specially identify samples if there could be a risk to other lab personnel.
As a newly minted veterinarian, it's validating to do a necropsy, find lesions, describe them, suggest some possible diagnoses, and have other tests confirm my analysis so definitively. Sure, I make mistakes. Sometimes I miss important lesions. Sometimes I don't collect the right samples. But I'm learning, and I'm gaining confidence in my ability to recognize when something is not normal. I may not always identify the disease process in detail, and I may not always properly rank what I see (abnormal doesn't mean important). But I'm getting exposed to a wide array of disease processes in lots of different species.
And I am slowly learning that I can leave work at 4:30pm and everything is just fine.
Tuesday, August 20, 2019
Archie, The Delicate Flower
For weeks, the outside temperature has been only a couple of degrees cooler than the surface temperature of the Sun. Nonetheless, Archie is convinced that he is not able to get even a moment of proper sleep at night unless his entire body is in contact with mine and he is covered with a blanket. As soon as Archie is ready to sleep (there's always play time first!), he will begin pawing at my arm, which means he wants me to lift up the edge of a blanket so he can slide under it, preferably right next to me. A complicated dance ensues as I try to cover him without having the blanket cover any part of me. Why would I need a blanket? I’ve got a 12-kg, fur- and blanket-covered heat factory attached to me all night long.
I'm quite excited that Archie starts agility class this week. The local club holds its agility classes outside, so I hope that it cools off as predicted in the next couple of days. I am not sure my delicate flower from the PNW is ready for the heat and humidity. I bought him a cooling vest, and plan to have plenty of cold water and a fan for him. For us both!
I introduced Archie and myself to the club via email. They asked me to do a brief skills test with Archie and one of their instructors. I thought that was reasonable and readily agreed. The instructor had come up with a rather difficult Jumpers-style course that was 17 obstacles in length but that only used 9 obstacles so most were repeated in various tricky ways. Archie of course crushed it. She then said, what about his contacts? I ran him up and down the Aframe a couple of times. He nailed that too. Weaves?, she asked. To show off a bit, I rear-crossed him as he flew through a set of 12 poles. No surprise, then--we are in the Advanced Class. It will be interesting to see how this goes for us.
I'd like to find a private instructor but that is going to take more time. We are going to need to start going to trials, get known by the AKC agility community out here, let word get out that I'm looking for that.
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