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Wednesday, November 29, 2006

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.......

Monday, November 27, 2006

First blog.

I have set up this blog for a number of different reasons. The first is boredom. Seriously. Though there is much to do in Toronto, I rarely avail myself of these opportunities. I am therefore quite bored. The second reason for which I am writing this blog is to share some aspects of my life with those who may or may not give a shit about it, plain and simple. For those who do: great, enjoy. For those who do not, kindly open up another web page. Yes, there are others. Another reason may be a tad more commendable: teaching. I have always enjoyed teaching others in a less formal, dynamic, and well, fun way. I am hoping that with this blog I can teach those that are not vets something about the profession. In addition, I invite all medical professionals to enjoy the site - to all those physicians who have naively asked me, "animals get that disease?", this site is definitely for you. It will show you that while veterinarians (particularly specialists) know much about human medicine, rarely, if ever, is the reverse true.
I have professional relationships with my clients and foremost, these must be protected. This does not bar me from writing about details of medical cases while protecting the names of those involved. Names of clients and their pets will not be mentioned here.




I'm less bored now as I'm in Arizona right now. Scottsdale to be precise. Lots of desert and home of the almighty SUV. The smallest car I've seen thus far is a plane. The cars are huge here. I like to imagine a Cadillac Escalade pulling up to a Mini Cooper at a traffic light, pointing, and laughing hysterically. I'd take the Mini Cooper any day.... There's nary a compact car to be seen - it's nauseating.
I'm thinking about the dog I treated right before leaving on vacation. Prostatitis with secondary pyelonephritis. This dog had an infection of the prostate gland (men get this) and it secondarily caused an infection of the kidneys. The image above is a radiograph of a dog with a severely enlarged prostate gland (cyst). This x-ray is similar to what I found in my patient except his prostate was the size of my head. It was pretty severe. He was doing well after a month of Cipro and neutering but I discovered he was mildly anemic (lack of blood, essentially) right before leaving on vacation. Why the anemia? I think there's much more going on. I'll find out soon.
In an unrelated story, I'm drinking a very nice wine right now.