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Friday, December 25, 2009

A sad case

A young, two year-old cat presented to me in severe and acute respiratory distress, severely hypotensive (low blood pressure), and vomiting clear fluid. The cat's gums were extremely pale and his temperature was a freezing 34.5 degree C (94.1 degrees F), indicating that the cat's extremities were very poorly perfused (no/little blood flow). The owner brought the cat in immediately after hearing the cat suddenly screech. There were no toxins to which the cat was exposed.

On examination, the cat's veins were hair-thin, so tiny that it was difficult getting an iv catheter in one of them - but we did. After giving the poor gasping cat a tiny dose of a sedative to calm him down, I administered a shock dose of iv fluids, which was touchy, as chest x-rays indicated that the lungs were full of fluid (could be blood, infection, edema, whatever), but I had to get his blood pressure up.
A presumptive diagnosis of anaphylactic shock or pulmonary embolus was made (the latter very difficult to diagnose in animals and people ante-mortem). I administered oxygen, injections of dexamethasone, epinephrine, famotidine (an antihistamine/H2 blocker for all you meddies out there), and Benadryl). Epinephrine was repeated twice in the next two hours.
Within ten minutes, the cat improved clinically with this treatment. The fluid rate was dropped, an injection of a diuretic was then given to relieve the fluid in the lungs, all the while the cat had watery fluid coming up from his lungs and pouring out from his mouth and nasal cavities.
Soon afterward, the cat turned blue indicating hypoxemia (low blood saturation in oxygen), so we gave him a low dose of milk of amnesia (propofol), intubated the cat, and manually ventilated him for over two hours. Watery fluid continued to pour from his nose. His gums returned to a normal pink with us manually ventilating him, but every time we extubated him to seet how he would do alone, he turned blue - not good.
We continued to intubate and extubate him but he could not ventilate on his own.
I advised the owners that he would need mechanical ventilation but such therapy in the ICU at the referral practice would have cost thousands, which he understandably didn't have. We extubated the cat, his breathing became severely labored so we put him out of his suffering and humanely euthanized him.
One of my technicians broke down crying... we were all so upset. I like to think that our efforts were noble. As vets, though, we always question ourselves: "Was my diagnosis correct?" "Did I do something wrong?" "Could I have saved this kitty?"
Fudge, this case didn't end well... but we tried.

Not the cat in question, but a cat receiving oxygen therapy.

Wednesday, December 16, 2009

Coming out... depressed may be more difficult than coming out of the closet. As some of my regular readers may know, I have not posted very recently in many months, since the rupture of a long-term relationship. Since then, I have entered into a "circumstantial" depression, call it what you will...
Right now, I am actually on my way out of it.
My life from the outside is fully functional, I continue to work, and to love work. In fact, in all modesty I don't think I have ever been a more caring and empathetic veterinarian, and have never felt like such a good diagnostician.
A part of me is hiding, though. A significant part of me hides behind a very thick veil of diversions, activities, and (sometimes) feigning of happiness. Another part of me is truly happy, truly functional, truly "me."
My friends and family in whom I can confide have been nothing but supportive, loving, and caring, though there is only so much they can do. It goes without saying that I am also receiving professional help...
I am discovering that my true purpose is not to be someone's better half, though I must confide I don't always buy this. Then what is my true purpose? There must be something, someone, waiting for me, and for whom I am also waiting.
I have decided to "come out" so that perhaps others may realize they are not alone, that we are all human, and that through suffering we can achieve greatness.