Death Is Coming

There are some terrible diagnoses in veterinary medicine. Rabies. Bad prognosis, inevitably grave meaning fatal meaning the patient IS going to die. There is not much you can do, just try palliative measures which you know won’t do much to change anything. The *HARDEST* conversations to have with a client. Much sadness all around.

One of these is DIC = disseminated intravascular coagulation. Also known by us in vet school morbidly as “Death is Coming.” A pet simply didn’t survive this diagnosis. Basically some kind of severe disease process initiates the clotting process in the body and then all the ability to clot is overcome and worse the body is unable to clot at all, and bleeding out occurs. An irreversible process. In theory one can treat the underlying cause and replace clotting factors until the body has healed but it just doesn’t happen. A bad bad diagnosis.

I had a patient in vet school. A lovely Pit Bull mixed with Labrador came in with a woman who worked for two equine veterinarians in far northern California. The dog had been vomiting and those veterinarians were so sure there was a foreign body somewhere in the dog they went to surgery. His owner described at one point the two doctors had their fingers touching, one down the dogs throat and the other reaching through its stomach and up its esophagus, yet couldn’t find the cause of the vomiting.

As it turns out the patient had pancreatitis. An inflammation that led to an effusion in the abdomen, ascites, and ultimately DIC. And the dog just looked at us wagging its tail, asking for a meal (the therapy includes no food or water by mouth to allow the pancreas to heal). It was suggested to his owner that the dog be immediately admitted to the ICU, where he could get around the clock care from multiple caretakers who would ALL be focused on his needs and surely the only way to possibly get better. It was anticipated it would take 3 to 7 days.

“No” his owner said, basically, “I’ll take him” — and everybody was looking at me. Crickets. Not quite exactly how it happened but essentially the ICU cost a lot and to be treated otherwise meant in the wards by the student. From 8a to 8p he was mine to keep alive. In the middle of the night the evening tech took care of it, following the orders I wrote but if there was an issue I would get a phone call or have to come in. Basically we poured an unbelievable amount of fresh frozen plasma into this dog. And literally we measured his belly to determine how well he was doing.

At one point his owner took him for a walk and allowed him to eat some horse poop. I could have strangled her. I told her we are not allowed to even eat ourselves in front of a patient with pancreatitis as the digestive enzymes get started and that causes further damage. Back to the wards. But amazingly enough he got better. Gotta love a Pit. Just totally indestructible.

“Wrong diagnosis” my friends said. Patients just don’t live thru DIC. But this dog did and he had all the proper lab value changes that are consistent with the condition. And he never clotted or bled. Perhaps because we were on top of his condition. Or he had just a “touch” of DIC. Who knows. I just know I did a whole heck of a lot of work and it actually worked!

The Point:

Even when given the worst odds, if the patient has any chance at all it is still worth trying.

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