Karmic punishment or a silver lining?


Being away for nearly two weeks attending continuing education does two things: The first few days back to the hospital on a normal working schedule make me very tired!

Being away for nearly two weeks attending continuing education does two things: The first few days back to the hospital on a normal working schedule make me very tired! So much so, the Starbucks' baristas recognize me and recite my drink order before I can open my mouth. Secondly, there's some sort of karmic punishment for being away. It seems like a fair number of interesting -- sometimes even difficult -- clients flock to my schedule.

The clichd silver lining to these aforementioned clients is Harley, a young kitten that I've been seeing for several weeks. It started on Tuesday morning. Typically, I see appointments until 10 a.m. and then head to the surgery room until lunch time. This day was different; I did not have any surgeries scheduled. So, I picked up a transfer from another hospital. The other hospital was sending the client with her kitten to us for a blood transfusion. As I heard it, the little one had a PCV of 8! Single digits are never good news, but I was willing to give it a shot. The only bit of fear that rose up in me was in knowing that I had not participated in a blood transfusion since veterinary school.

A couple hours later -- after reviewing the kitten's history (mostly unremarkable and the owner had done everything her veterinarian had asked), completing a physical exam and then pouring over a couple textbooks to figure out the math behind transfusion medicine -- the kitten was receiving a blood donation from one of our senior doctor's cats. The kitten was so lethargic and didn't seem to care that there were two IV lines flowing into her. Warmed up, the smelly, soft kitten food didn't interest her either. If I could get her PCV up, I would feel more confident about telling her owner that the prognosis was at least guarded. I crossed my fingers and toes, and continued to monitor her.

Two days later, her PCV was up to 15 and holding steady after several PCV checks. She was not out of the woods yet, for sure, but she was eating her kitten food, cuddling up to me and the other team members. She wanted to be a kitten again. She was discharged the next day, on my day off. One of my colleagues instructed Harley's owner that it was important to realize that we still did not know what caused the anemia, and we needed to monitor Harley for several weeks. (CBC revealed no blood parasites, and two separate FeLV/FIV tests were negative previously.)

The call went out to an internal medicine specialist at a diagnostic laboratory. We established that the kitten had a mild regenerative anemia, and that it might take several rechecks to Harley's hematocrit and white-cell count to normal levels.

The little one finished her antibiotics and continued to come in regularly. At her last recheck before I left on my traveling spree, her hematocrit was normal (34!), and her WBC count was coming down, slowly.

Harley was my first patient yesterday morning. She had become a Velcro kitten, quite attached to her owner. I still have not heard her "meow," but she seemed so bright and happy. Her mucous membranes were the pinkest I've seen, and her owner, who had been diligently checking them, agreed. I was confident that the CBC results would be fantastic. Her owner and I discussed that as long as her CBC results were within normal limits, we could schedule her spay in the near future, too.

That was good news for the owner; Harley is the only pet in the home that isn't spayed or neutered, and the owner wants it done as soon as possible.After all the "interesting" clients in between Harley and the end of the day, I saw that Harley's CBC results were returned sooner than I had expected. Her chart made its way back to my cubby with the lab report sticking out perpendicular to the medical record. I pulled out the lab report and was disheartened to see that the hematocrit was only 0.3 points higher than it was three weeks ago. And my heart sank even more to see that she still had a leukocytosis, and it was significantly higher than the value three weeks ago.When I return to the office, the very first thing I will do is place another call to the laboratory to seek another opinion on Harley's not-as-wonderful-as-I-had-hoped bloodwork. It does not match her clinical picture. I think the next step might be a bone-marrow aspirate, but before proceeding with an invasive diagnostic such as that, I want some reassurance that I am moving in the right direction to figure out her case. While I'm waiting on the return phone call, I will definitely talk to my colleagues, too. It is a benefit of being in a practice with a large number of doctors. There's always another colleague to consult with and perhaps give me a different perspective or ask a question that I had not thought of before that will be the missing link in a definitive diagnosis. Harley's story will continue soon?

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