Compartment Syndrome: What's a vet to do when it's your dog that needs the care? : Musings from Dr. Knox
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A day in the life...a blog presented by Dr. Knox Hilliard on topics from preventative veterinary care, cool cases and sometimes just plain sarcastic humor. 

Compartment Syndrome: What's a vet to do when it's your dog that needs the care?

by Knox Hilliard, DVM on 04/19/17

So I've officially decided to come out of hiding now that it's been 10 weeks since the Falcons lost the Super Bowl. There have been quite the abundance of "life calls" type situations that have impacted my ability to share my thoughts to the world in all honesty, but I've decided it's time to make time. 


First of all I'd like to start by thanking our INCREDIBLE staff at the clinic for all the hard work they've done the last few months. Our month of March was one for the record books and we did so while being down a couple employees for various reasons, so to Tammy, Kori, Courtney, Gloria, Wendy, AJ, Emily and Rachel (and I guess me boss too): Thank you for all your hard work, staying late without being asked and not complaining one bit about it, picking up the load for one another, and not strangling me when my back was turned. It's greatly appreciated.

I'd also like to thank all of our clients for your patronage. Without you all, I wouldn't be able to work my employees into the ground, and for that I'm forever grateful. 

As for the title of today's blog post: Compartment Syndrome. Some of you in the medical profession may be aware of what exactly this phenomenon is. If you're not, then click here (unless you've got a light stomach, then click here). That's not the type of Compartment Syndrome I'm referring to. 

What I mean rather here is the ability to compartmentalize things: to keep the practice of medicine the same regardless of the circumstances. To separate work from home. To respect that coworker despite their criticism of your job performance being hard to hear. Or when they tell you they think you've got an addiction to Tootsie Rolls and Fruit Roll-Ups (IT'S JUST A SWEET TOOTH LEAVE ME ALONE). 

I had to experience this first hand last week. Our family dog Swagger, an 11 year old purebred English Springer Spaniel had been showing recent signs of age. I initially attributed it just to father time and cold-blooded, savage disposition towards life, but then about a month ago he developed acute epistaxis (bloody nose). This is never, ever, ever a good thing in a dog. 

So I began to monitor his bloodwork weekly and examine him every other day. He was becoming progressively more anemic (meaning his red blood cell count was becoming lower and lower) and his abdomen was becoming more and more distended. Ultimately I took some abdomen x-rays which revealed what I had feared most: a mass in his cranial abdomen. This typically (99.9% of the time) means one of two things: Liver mass or splenic mass. The latter was my hope, as splenectomies are procedures dogs handle quite well, and I've done more than my fair share the last three years. Thought splenic masses are 2/3 of the time malignant, and 2/3 of those hemangiosarcomas (bad bad bad bad), there's still a 33% chance things could be good and surgery could be curative. (Just ask our technician Tammy- I removed her dog Ben's spleen two weeks ago and based on appearance was nearly CERTAIN it was malignant hemangiosarcoma. Histopathology came back as extramedullary hematopoeisis and surgery is curative. HALLELUJAH! #bestvetever #evenablindsquirrelfindsanut). 

Unfortunately given the progression of his anemia, it was time to make a very painful decision: open him up and explore his abdomen or consider the most difficult option, humane euthanasia. Anyone who knows me will attest that "quitting" is not in my vocabulary. I exhaust every single opportunity possible for my animals and my client's animal's (provided a single condition is met- we are able to make certain undo suffering or pain isn't occurring) before I say it's time to consider the final option. So to surgery I went. 

I'd never done surgery on a family dog, one that meant so much to me before. It was something I was struggling with mentally and emotionally until the warm water of the scrub sink hit my hands and snapped me out of it. I told myself I was just about to perform an exploratory laparotomy on Mrs. Jones's dog Fluffy, and that I'd do nothing different for Swagger than I would for any other client's animal. I wanted everything the same. I even wanted my usual Ed Sheeran playlist on the stereo in the surgery suite (#mancrush). When I entered the abdomen, I experienced the visceral type of reaction one only feels when returning home after a two week vacation only to realize they left the eggs and gallon of milk outside the fridge: what is that?!? followed by a titch of nausea. 

Swagger's liver was eaten up and consumed by cancerous nodules on all liver lobes. At least a dozen. One of which was the size of a baseball and the obvious source of his bleeding and recent anemia. So I did what I do: I tried to fix what I could. I performed a liver lobectomy on that lobe which had the bleeding tumor, something I'd never done before. But hey, I stayed at a Holiday Inn Express the night before  in anticipation. 

I was able to finish the surgery up (which admittedly seemed to take hoursssss) conveyed my post-operative orders to my anesthesia tech then calmly walked down to my office, closed the door and proceeded to lose it. I'm not sure how I had the strength to do such a procedure on an animal that was so dear to me and that I had literally no experience doing. Somehow God blessed me that day with the ability to compartmentalize "my" patient the same way I would "your" patient. 

Fast forward a week, Swagger is doing amazing. He's got more pep in his step, his anemia has improved, his appetite is back, and he's overall nowhere near as uncomfortable as he was prior to surgery. And his e-collar gets GREAT reception- I can now catch up on Designated Survivor thanks to it. His prognosis (presumptive metastatic liver disease) is poor, best case scenario probably two months. But had I done nothing he wouldn't have made it to last weekend I'm convinced. So I was able to buy him some time, but more importantly than that, buy him some GOOD time. 

I'm often asked why I got into veterinary medicine. My answer is always because I like animals, but I LOVE humans. I personally just find something so unique, refreshing, satisfying and beautiful about the bond between a human and an animal. They're the one thing that no matter how crappy your day is, or how late your bills are, or whether your coworkers made fun of your pants will always be there for you with unconditional love. Provided you remember to feed them. So I guess one-conditional love. 

But I got into this job because I love people, and helping people through helping their animals whether they be sick, need wellness care, or their owners need the reassurance that they're making the right call when it comes to end of life care, I take everything I do very, very seriously. I'm blessed to work with a group of amazing women who do the same, provide constant laughter, and a father who has been there for me whether I need an opinion on a set of x-rays, an opinion on how to approach a hard to handle client or just advice on life in general. And who will smoothly transition from a discussion about Cushing's disease to how to Dawgs offensive line will be able to hold up this season and protect Eason. Thoughhhhh we'd LOVE to see our hometown boy Jake Fromm get a shot early and often...

We all have compartments in our lives. We've got our family compartment. We've got our work compartment. We've got our spiritual and religious compartment. And we've got our miscellaneous compartment (cough Georgia football Falcons Braves music cough). I hope and pray that I'm able to continue to compartmentalize the things that are necessary to keep practicing high quality, competent medicine for every patient I see for the rest of my life. I don't promise that I'll fix everything or cure every problem, but I do promise I will exhaust every resource, read every case study, delve through textbooks like I'm at a law library (quiet, please!), call anyone of the specialists I worked with in the past to come up with the best possible plan. I promise that, and the day I no longer make that promise is the day I hang it up and start greeting at Wal-Mart. I'd love that job. 

So to tie all this together, we live in an imperfect world. We lose things. I lose my keys (HIGHLY recommend purchasing a Tile for such problems) on a daily basis. But when I say lose things, I mean we lose things that are dear to us. Whether a spouse, a friend, a dog, a cat, a goldfish, or your Minivan because you parked at the Watson Blvd. Kroger, it's dark outside and raining. But loss is an inevitable part of life. I truly hope that for all of those of you that have nothing better to do than read this far that you can find that compartment where you keep the pain of loss. But I hope you do so by stacking the pain way down on the bottom and putting the memories of happiness shared on top of them. Compartment syndrome: Not to be confused with Apartment Syndrome. We all have the stories about that one roommate that had that one habit that seemed innocent at first until it kept you from being able to fall asleep and rehashing it here gets us nowhere. But if you'd like to share those roommate stories, feel free to email me anytime as I often need something to make me laugh in the middle of the day. 

And shameless plug time: I attend Centerville United Methodist Church and am a very active member. I am taking charge and starting a new, extremely laid back Sunday school class for young adults (basically anyone in college to early 30's) where we will meet and discuss life in general and how it relates to faith. You don't have to even ever have held a bible to attend. It will start early to mid-May, so if you or anyone you may know is looking for a church home or a chance to meet with like minded (or at least similar aged!) folks in a low stress, cool environment then I'd LOVE to have you join us. I have from time to time been known to tell funny jokes. Again, the emphasis is going to be laidddddd-backkkkkk so no need for anyone to feel intimidated about it. If you're interested feel free to email me at KnoxHilliardDVM@gmail.com  for more details. 

Until next time, my friends. MAYBE SOME TEAM I CHEER FOR WILL WIN SOMETHING BEFORE THEN BUT I DOUBT IT. 28-3 lead. Unbelievable.

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