Your Dog is Weird

The words you definitely want to hear coming out of your vet's mouth right?

Last night Guimauve had diarrhea every two hours. This sort of started Friday with some diarrhea, but Saturday his stools were mostly normal until the evening. I had a suspicion it was the metoclopramide we started him on to increase his gastric motility.

This morning I had to go into the hospital early to run blood from the research project I am working on, so I figured I would stick my head in and see if Marcie was in. Voila! I was in luck she was in. I told her what was going on and she said she would call Dr. Costa in a bit when it was not quite so early. I spun the blood down and returned to find Marcie.

Today was my lucky day, Dr. Costa happened to be working at the hospital today and was learning about the cases received overnight and then I could talk with her. Not long after Marcie tells me this Dr. Costa walks through the doors and stops dead in her tracks and looks at me then Marcie and back to me with a look of "Oh no, now what?!" on her face. I felt kind of bad, but at the same time it was a pretty priceless look.

I explained to her the diarrhea and we decided to take him off the metoclopramide which seems to have worked so far.

As I was walking away Dr. Costa told me I had a weird dog and I just smiled and shook my head saying I know.

The Saga: Part Deux

I forgot to provide the results of the fecal received yesterday!!! So working in WADDL I had the inside, unofficial results. 10 oocysts (a cyst containing a zygote of the parasite) per gram of coccidiosis. So of course I tell Dr. Costa and the problem is it is not enough to be pathogenic. However, never hurts to treat! So he got Drontal Plus (anti-parasitic) as well as Albon an antibiotic.

And now for today. I bring him in early and Marcie (the awesome and stupendous 4th year student on his case!) tells me they have two options for his endoscopic biopsy. At 11am or 3pm. So of course at 11 I call and find out he is going in. Not even 30 minutes later I get another call, Guimauve's stomach was full of food! So I get the (nice) Spanish Inquisition as to how he might have grown opposable thumbs and opened a refrigerator door to get to the canned food. For everyone's knowledge he is on z/d at the moment. z/d is a food for dogs with allergies so it is pretty much hydrolyzed chicken (easily absorbed) corn starch and water with vitamins and minerals. Guimauve practically inhales it though!

+1 on the problems list. Delayed gastric emptying. (I can't help but picture House and his white board and thinking "One of these problems is not like the others"). The food in his stomach prevented them from getting a biopsy. I talked with Dr. Costa and Marcie about our weekend strategy when I picked Guimauve up. The top of the differential list is still a protein losing enteropathy.

So we have several directions to go now. First choice was to put him on metoclopramide to treat the vomiting that occurred from a full stomach and going under anesthesia as well as increase gastric motility for the weekend. Continuation of the plan is to have him off food and medication on Sunday night/Monday morn. Then he goes through a Barium study. Barium is a mineral that will show up on x-ray or in his case fluoroscope. Fluroscope is like an x-ray type machine that gives "real time" x-rays. This way they can determine strength of gastric contractions, motility and measure the amount of time it takes for food to pass through his digestive tract.

Once the time is determined we will then know how long to fast him before the endoscope and potentially solve why he has reduced gastric motility.

Plus Guimauve is becoming a blood donor, he gets to donate again Monday for cobalamin/folate levels. These tests measure the amount of cobalamin/folate absorbed. Folate is absorbed in the proximal intestine while folate is absorbed in the distal small intestine. This may help pinpoint where the problem is in the intestine. Another test is the trypsin-like immunoreactivity (TLI) which is an indicator of pancreatic function.

So that is where we stand now!

Thanks to everyone for your good wishes and for stopping by and visiting me and Guimauve!

The Saga Continues

Yesterday Guimauve went in for some more tests. Dr. Costa (the intern working on his case, she's awesome!) told me his second bile acid test was slightly elevated but not to the point of providing any direction. His cortisol baseline was also tested to rule out Addison's Disease. It was not abnormal so they put that aside for the moment. Normal baseline cortisol levels do not completely rule out Addison's, but it is a good indication.

Addison's is a disease where the body does not produce enough cortisol which is important in helping the body respond to stress, maintain blood pressure and cardiovascular function, slow the immune system's inflammatory response, maintain levels of glucose in the blood, regulate the metabolism of proteins, carbs and fats; etc.

There was still no specific indication whether or not his problems were GI or liver related. The next decision was made to do a focal ultrasound of his abdomen (focal is cheaper and they look at only specific areas). They checked his liver, bowel loops and mesenteric lymph nodes. The liver looked normal, putting shunt at the bottom of the differential list. The bowels looked normal. His mesenteric lymph nodes were slightly enlarged. Add another problem to the list.

This gave some more options for diagnostics. Aspiration of the lymph nodes which would determine whether they are normal or not. I declined because it would not lead to a specific diagnosis. The only way to specifically diagnose what is wrong with his lymph nodes is surgical biopsy, which is not an option. Plus, they could just be enlarged due to GI issues. The other option for enlarged lymph nodes is lymphoma which is at the bottom of the differential list.

After the ultrasound Dr. Costa and I discussed the next options. Surgical biopsy of liver, lymph nodes and intestine OR endoscopic biopsy of his intestines. The pros of surgery: we get to see more and get good biopsies of everything. Cons: His low protein means lower ability to heal and he would have to be under anesthesia longer. Pros to endoscope: Get to see the stomach and intestines from the inside. Cons: Biopsies are not the best and usually not full thickness of the intestine. Cannot get biopsies of liver and lymph nodes.

Based on pocket book I picked endoscopic biopsy. I fed him about 9:30 last night and then took him in this morning. And now for part deux....

The Inevitable of Being a Vet Student

Not that many people really follow this since I am a major slacker! But for the benefit of my fellow vet students and other curious folks, I present a case. The Case of Guimauve (Pronounced Ga-move or Gi-move depending on your French accent).

Guimauve is my 18 month old papillon. When I got him the end of March he was fairly thin. The breeder stated that he was at a show facility and came back to her that thin. Got him back to Pullman and he was eating like a pig and doing great. Took him in to the vet hospital at the beginning of April for a severe cough. They put him on drugs and he got better. Beginning of May got the little bugger neutered and his teeth cleaned. Before his surgery he had gained almost half a pound! Yay! (For a dog about 4 lbs that is quite a bit)

I took him to Spokane and left him for a bit so he could adjust to farm life and socialize with some other dogs. Mum began to worry because he had a gastrocolic reflex of a puppy which he did not have when I got him. Gastrocolic reflex is the reason why puppies have to poop 20-45 minutes after they eat.

Mum took him to a vet in Spokane on June 8th. They ran a fecal and it came up negative for parasites. Vet advised her to continue as she was.

I talked with the breeder on 6/21 to see if she had any knowledge of something similar in any papillons. I was informed that coccidiosis was found in Guimauve's littermate and one of her other dogs.

On 6/22 mum took him to the holistic/acupuncture vet in Spokane. He had been depressed for a couple of days and she was still concerned by his lack of weight gain. The holistic vet determined he had abdominal pain and bradycardia (low heart rate) and he needed to get some blood work done and possibly an abdominal ultrasound to determine liver or GI disease.

Mum brought him to Pullman and we took him to the hospital. The doctor looked him over and determined a basic chemistry profile and CBC were warranted. Some of their differentials included a Protein Losing Enteropathy which is a condition of the GI tract that causes a net loss in proteins, liver shunt, fat malabsorption (pancreas) and parasites. Also, she took blood for a fasting bile acid level test. The acid bile test came back as not too high but enough to get the second bile test that evening.

When I took him in that evening I was informed that his albumin was very low. Normal is 2.5-4.3 and his was 1.6. Albumin is a protein that is produced by the liver. It is the main protein in blood plasma and is very important in transport of things through the blood as well as platelet function. Needless to say hypoalbuminemia is bad.

Today (6/23) I am waiting on bile acid test #2 results and fecal results. Next step is possible intestinal biopsy via endoscope. Funny part of all this is the fecal samples and, if the biopsy is performed, those samples will all go to the lab I work in, WADDL. Not my specific division, but just the lab next door.

Well ladies and gents, there is a case study for you! I will keep you updated as things progress.

They Say It's Hard, But Never Say It's Fun

The first week before vet school was actually vet school 'orientation'. They call it COLE- Cougar Orientation and Leadership Experience. We had lots of fun games, communication lectures and team building exercises. I had a ton of fun and really learned a lot. We were 'camping' (sleeping in cabins is really not camping) on the Spokane River in Post Falls. It was great to help us get to know each other, all 99 of us first year vet students. Plus second and third year students were there as our mentors and talking to them really helped to settle my nerves.

Then there is this first week of actual school. My class list is as follows:

Small Animal Gross Anatomy
Microscopic Anatomy
Cell Physiology
Principles of Surgery
Animals, Society and Vets (Continuation of COLE through our 3rd)
Animal Handling and Ag. Animal Orientation

Electives:
International Vet Medicine
Colic Team

So far in anatomy we have studied the bones of the thoracic (front) limb. Today we started dissecting our cadavers. We are working on learning the origin and insertion of the muscles of the thoracic limb.

In micro anatomy lab we spend our time looking under a microscope. This week we have been looking for parts of the cell in different tissues.

Cell physiology has no lab. In class we are learning about DNA/RNA replication, transcription, translation, etc.

Principles of surgery is once a week with a lab every other week. I have not had my lab yet, but my classmates have said the lab was fun working on gowning up while keeping sterile, suturing and learning the various instruments.

Animals, society and vets is an interesting class. It is kind of a break from all the intense vet learning and focusing on important topics in veterinary medicine and working on our communication skills. We start various readings next week.

Animal handling and Ag. animal orientation sounds like great fun. We basically had an introduction to what the class is and we start labs next week. We have labs within the various clinical areas such as Small Animal, Equine, Ag animal and veterinary teaching hospital orientation. We get oriented to the hospital because we have badges which allow us total access to all the buildings of the vet school.

Today I watched a student put a catheter in a calf, nothing new for me to see, but good to see how they do things differently around here.

The International Vet Med class is pretty fun. It is during our lunch hour so we pretty much listen to a lecture on opportunities abroad or Animal-Human issues abroad while eating lunch.

Tomorrow I have colic team for my lunch elective. We will see what that entails. I hope we do have some colic cases this semester so I can learn from them, but then again any colic cases is a bad thing because someone has to go through that experience with their horse.

Tomorrow is also the club BBQ where I can sign up for clubs and see just how busy I can be this semester!

All in all I'm enjoying every minute I am here. A little sleep deprived, but not too much yet. Once I get my schedule down I will be working hard but loving it!

The Start of the Vet School 4-Year Run

I WILL be better about posting, especially since I will hopefully have some great stories going through school! First post has to have this weird video that the vet school e-mailed to all the students. It's not really funny, but it is interesting. Enjoy!

http://www.xtranormal.com/watch/6868901/

Update!

1. I'm in vet school, barring some disaster where I fail Biochem. I've only received one packet from them, so not sure if I should be worried or not lol.

2. I am working part time for the 4-H extension office as a "Clerical Assistant III" AKA anything the rest of the staff doesn't want to do...yeah that's me. I've determined I'm office or "four walls" claustrophobic when it comes to working. Plus who wants to be inside on such beautiful spring days?

3. I am again working for Ore Grade, Inc. I've got to work with manners on a two-year-old gelding and the two yearlings (foals last year) that I halter broke. I've also got to retrain a quarter horse that is off the track. Should be an interesting experience.
I've got to come up with a nickname for the yearling. He is light on his front feet (basically he likes to rear and/or strike).

That's all for now!