Crazy day.
One of my favorite patients has a technically fatal disease but I have kept him alive and kicking and mostly neurologically normal for 2.5 years now. Lots of scary medications which require lots of micromanaging to have the desired effect without bad side effects. Anyway, he came back in last night with a relapse of his symptoms. He had his 4th lifetime MRI and spinal tap today and, yep, his disease is back. The problem is that I have already given him his max lifetime dose of my most effective medication, I have moved on to a complicated treatment regimen of four other meds and I don't have too much left in my back pocket for this dog. I have come up with a fresh game plan that is sure to work in the short term but hard to know where we will be four months from now. Yes these people are rich BTW. Dad is a big time lawyer. All I can say is thank God for the celebrity screw up.
Then my first appointment was a laterally recumbent 18 year old cat with symptoms relating both to the inner ear and adjacent brainstem. The best thing is could have been is an inner ear infection that has spread to the brain and that is honestly not a very good thing to have, requires a very major surgery, too major IMO for an 18 year old cat. I'm sorry Lady-I-Just-Met-Fifteen-Minutes-Ago, the only realistic option is to euthanize your cat.
Also rechecked my happy-go-lucky 4 year old epileptic pit bull, who was coughing last month and was diagnosed with heart failure. A genetic form of heart failure called dilated cardiomyopathy. Maybe 4-12 months to live, that is some very bad luck. Had two seizures recently, which we really don't want, it will stress the heart further. Reviewing her bloodwork from her heart-failure hospital stay a month ago, I'm worried she may be developing a liver toxicity from one of her seizure medications. Something I can reverse by weaning her off the medication but then the seizures may get stirred up again so I totally hope the liver function test comes back ok.
The a little Chihuahua type dog with excruciating neck pain. Based on xrays, there's a 90% chance the pain is from a disc herniation and there's a 90% chance I can totally fix the dog instantly with surgery, its amazing how usually these dogs wake up from a major spinal surgery and feel so much better, sometimes they can even go home the very next day. But its a young couple, no money to spare on something like this. I have whittled expenses down as absolutely far as I can, and offered them a discount on top of that. They have good credit, just don't know they should go into debt fixing their little dog. The girl was crying and wondering if they should be thinking euthanasia, she can't stand to see the dog in pain. I talked her off that ledge, I hope it does not come to that, I have loaded that dog up with pain meds and anti-inflammatories and muscle relaxants and we are going to see how it goes through the weekend. Maybe we will do surgery next week if the pain doesn't get better.
We did have some really good rechecks- a dog with terrible epilepsy, used to sometimes have 20 seizures in a day, annual recheck exam and he has only had one seizure this whole year. A cat with a muscle disorder, first recheck exam since diagnosis and he is markedly improved on meds, couldn't really walk two weeks ago and now he is running around the house chasing the other cat. Encephalitis recheck doing great.
Interviewed a kind of weird guy for an intern applicant. And two more phone interviews. Plus maybe 6 more email exchanges, it was a busy day. Did get in a nice trainer workout this morning. And I have some nice rides set up for this weekend, sweetness on that.
