Week 2 on Internal Medicine / Cardiopulmonary Medicine

Tomorrow is the start of week two on rotation with Internal Medicine / Cardiopulmonary. Last week was extremely busy and I loved every minute of it! Each day we had to take a case that had either come in overnight or was due to come in for that particular day. I had taken on a case that was a cat with chronic neutropenia and lymphadenopathy. It had developed pleural effusion and came in for dyspnea and severe respiratory distress. It was sent home mid-week but was re-admitted, as it had collapsed at home and required thoracocentesis to drain 175ml from its pleural cavity! Lots of fluid for a little kitty! It was due to go home on Saturday but on my Friday 4pm check just before I had to be at a special seminar, I noticed the breathing pattern had changed slightly. There seemed to be more of an abdominal component with each breath. I called the primary clinician over to double check and she decided to perform a fast echo on the cat. Sure enough, the pleural effusion had returned. So much for the seminar! I spent the next 1.5 hours sedating the cat and draining the fluid from its chest. Needless to say, the cat did not go home on Saturday. Not sure if the cat will be there tomorrow or if other decisions were made over the weekend... I had another 2 cases I followed all week. I had an 18 month old cocker spaniel puppy that came in with hypoalbuminemia, peripheral edema and generalized erythematous lesions. It stayed with us for a day and went home the next day as the albumin levels had risen to within normal reference range. We deemed it a hypersensitivity reaction with severe hypoalbuminemia. We worked it up for liver disease initially as PLN and PLE were both ruled out at the referring vet. Question for the vets reading this, have you seen hypoalbuminemia around 17g/L in hypersensitivity cases? There was an argument as to what level of albumin would cause peripheral edema. The last case I had, was a labrador that was 13 yrs old that came in for a month-long cough. We did abdominal ultrasound as the referring vet was worried about an abdominal mass. Ultrasound was insignificant and we then performed CT scan, which again showed no abnormalities. Bronchoscopy revealed a 4cm long grass blade lodged in the right mainstem bronchi! We removed the foreign object and put the dog on anti-inflammatory and antibiotics. Was a satisfying case to have! I went to Perth on Saturday for hiking and spent the remainder of the weekend studying for NAVLE. I can't wait for the NAVLE to be over and done with! I haven't had much time to study for the NAVLE during the week as I have had to prepare for cardiac tutorials and work up my cases for each morning at rounds. Every morning we have to discuss our cases that each of us has with the clinicians. So I have a lot to go over tomorrow! Surely there will be a lot of treatment that occurred over the weekend with the kitty cat. Hope all is well with everyone and I will update again as soon as I have a spare moment!