Internal medicine is picking up speed as the week progresses. I had a relativly easy start to the week, with 2 hepatitis patient rechecks on Monday and my rock-eating buddy Emmie on Tuesday.
Yesterday, I had a dog with a 10 month (yes *10 month*) history of straining to defecate and fresh blood in his stool. After much rectal examination and poking with many needles, we diagnosed him with a perianal gland tumor, which, in his case, probably has few treatment options. His owners elected to try a diet change, antibiotics, steroids, and stool softeners to see if they can keep him more comfortable for a little while.
My second patient yesterday was a transfer from Urgent Care -- a DKA (diabetic ketoacidosis, "diabetic crisis") dog also with severe pancreatitis and a gallbladder mucocele. The mucocele was a "bonus" find on the ultrasound. Mucoceles generally head to emergency surgery, but this poor kiddo is so sick that we're taking a chance with managing her medically for awhile, and hoping her gallbladder doesn't burst in the meantime. It's a really interesting case, and I hope to have time to blog about it soon! However, as these things go, the more interesting and busy the caseload is, the less time for blogging...
Thursday, February 16, 2012
Wednesday, February 15, 2012
Lesson #895: Don't eat rocks
Yesterday's internal medicine patient was a 9 month old Lab named Emmie.
Emmie presented with the complaint of rocks in her stomach. Upon further discussion with Emmie's mom, I learned that this is Emmie's third offense of rock-eating in the last 4 months, with the first 2 offenses requiring abdominal surgery to remove (count 'em) 7 rocks the first time and 15 the second time.
After Emmie's second offense, her mom completely re-landscaped the yard and thought there were no rocks left for Emmie to access. However, Emmie discovered a hidden cache of rocks and gleefully chowed down.
Two days earlier, Emmie vomited up 5 rocks at home. Her mom brought her to an ER clinic, where vomiting was induced and Emmie produced another 5 rocks. However, abdominal rads showed that Emmie still had 4 rocks in her system.
Emmie spent a day at her rDVM on fluids, hoping the rocks would pass one way or the other. However, repeat radiographs yesterday morning showed 3 rocks in Emmie's stomach and 1 in her colon.
Since Emmie's mom (understandably) didn't want Emmie to have a third abdominal surgery at the tender age of 9 months, she hoped we could get the rocks out endoscopically.
Endoscopy requires general anesthesia, but once a scope is passed through the mouth and esophagus into the stomach, it is often possible to retrieve foreign objects like rocks, coins, hair bands, and tampons using graspers or a wire basket to pull the objects out through the mouth. In most cases, surgery can then be avoided, though in a few disappointing cases, the objects cannot be removed endoscopically and the animal ends up in surgery anyway.
Emmie's first two rocks came out with moderate difficulty. The rocks were very smooth, so kept sliding out of the wire basket. However, within about 30 minutes of starting the procedure, we were 2 down with 1 to go.
The third rock was the smoothest, and was also very long and thin, so it was difficult to get the basket seated around the rock without the rock just slipping out. But after about 2 hours of trying for this rock, with the combined efforts of 3 boarded internists with massive combined experience using the endoscope, the last rock was finally retrieved! In comparison, this type of foreign body removal is usually accomplished in about 45 minutes.
Emmie's mom was thrilled to have her leaving the hospital the same day, with nary an incision, suture, or cone of shame. Now the hard part begins again -- keeping Emmie away from rocks for the rest of her life! It's possible that Emmie may have an underlying disease process like a liver shunt or exocrine pancreatic insufficiency, that may be causing a nutritional deficiency that makes her feel like eating rocks (which is called pica -- a desire to eat non-food objects). But given that Emmie has seemed perfectly healthy her entire life except for eating rocks, it's probable that her rock-eating is simply an annoying habit that will have to be managed. Say hello to the basket muzzle!
Emmie presented with the complaint of rocks in her stomach. Upon further discussion with Emmie's mom, I learned that this is Emmie's third offense of rock-eating in the last 4 months, with the first 2 offenses requiring abdominal surgery to remove (count 'em) 7 rocks the first time and 15 the second time.
After Emmie's second offense, her mom completely re-landscaped the yard and thought there were no rocks left for Emmie to access. However, Emmie discovered a hidden cache of rocks and gleefully chowed down.
Two days earlier, Emmie vomited up 5 rocks at home. Her mom brought her to an ER clinic, where vomiting was induced and Emmie produced another 5 rocks. However, abdominal rads showed that Emmie still had 4 rocks in her system.
Emmie spent a day at her rDVM on fluids, hoping the rocks would pass one way or the other. However, repeat radiographs yesterday morning showed 3 rocks in Emmie's stomach and 1 in her colon.
Since Emmie's mom (understandably) didn't want Emmie to have a third abdominal surgery at the tender age of 9 months, she hoped we could get the rocks out endoscopically.
Endoscopy requires general anesthesia, but once a scope is passed through the mouth and esophagus into the stomach, it is often possible to retrieve foreign objects like rocks, coins, hair bands, and tampons using graspers or a wire basket to pull the objects out through the mouth. In most cases, surgery can then be avoided, though in a few disappointing cases, the objects cannot be removed endoscopically and the animal ends up in surgery anyway.
Emmie's first two rocks came out with moderate difficulty. The rocks were very smooth, so kept sliding out of the wire basket. However, within about 30 minutes of starting the procedure, we were 2 down with 1 to go.
The third rock was the smoothest, and was also very long and thin, so it was difficult to get the basket seated around the rock without the rock just slipping out. But after about 2 hours of trying for this rock, with the combined efforts of 3 boarded internists with massive combined experience using the endoscope, the last rock was finally retrieved! In comparison, this type of foreign body removal is usually accomplished in about 45 minutes.
Emmie's mom was thrilled to have her leaving the hospital the same day, with nary an incision, suture, or cone of shame. Now the hard part begins again -- keeping Emmie away from rocks for the rest of her life! It's possible that Emmie may have an underlying disease process like a liver shunt or exocrine pancreatic insufficiency, that may be causing a nutritional deficiency that makes her feel like eating rocks (which is called pica -- a desire to eat non-food objects). But given that Emmie has seemed perfectly healthy her entire life except for eating rocks, it's probable that her rock-eating is simply an annoying habit that will have to be managed. Say hello to the basket muzzle!
Subscribe to:
Posts (Atom)
