- 2 weeks ago
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00:03Hello, Milo's ready.
00:04He's really sick.
00:05We took him to the vet about 30, 40 times.
00:08Being on antibiotics that many times
00:11is definitely a red flag.
00:12There's something we're missing.
00:14Fox, his fever could lead to organ dysfunction
00:18and even death.
00:20Start cutting.
00:20It's very hard what you're going through.
00:23You see the bleeding there?
00:24Doing great, Luna.
00:26There's a lot of pressure.
00:27Ready?
00:27Ready.
00:28We can't intubate her, so it's scarier.
00:31It's life or death for this patient.
00:47Okay, Mr. Mann, we're going to take care of you.
00:50When pet owners have tried everything...
00:52Okay, good boy.
00:54Dr. Lauren Edelman, an internal medicine specialist,
00:58takes on the cases no one else can crack.
01:01He's got elevated liver enzymes,
01:03so we're going to hunt that down.
01:04My job is solving mysteries.
01:07It's just weird that it's really just affecting the back legs
01:09and not cranially...
01:11I won't stop until we get an answer.
01:14Good morning.
01:15Okay.
01:17This morning, she has an unusual case.
01:21It is a freaking maze in here.
01:23She's got a long snooze.
01:25She's got a long mouth.
01:26Piper, a seven-year-old husky, has been suffering from severe sneezing
01:31and nose irritation for weeks.
01:33There's quite a bit of mucus and secretions.
01:36A CT scan revealed something abnormal,
01:39and Dr. Lauren suspects Piper might have an object
01:43stuck deep in her nose.
01:45Looks a little irritated back here.
01:48Dogs get lots of really interesting things up their noses.
01:51The majority of the time, it's plant material,
01:54like blades of grass, seeds.
01:56I pulled once a dog that had weirdly inhaled, like, a walnut.
02:01And then, of course, just like children,
02:03they can get things like beads and little toys up their nose, too.
02:07I'm not saying, like, fungal plaques,
02:10but I'm not saying a foreign body either yet.
02:12So I can't say for sure whether there's something up there.
02:15Sometimes it's not clear based on CT, but we have to check.
02:20If there is something in Piper's nose,
02:22it could lead to infection or damage to her airway.
02:27There's so many nooks and cradies in the nose,
02:29you really have to know where you're looking.
02:32The nasal cavity is made up of all sorts of cartilages
02:35that are, like, winding and turning and folding amongst itself,
02:38and there's a reason for that.
02:40It's providing a lot of surface area to filter things
02:43as they come into the body
02:45so that it doesn't make it into the lungs.
02:47However, because of a maze-like nature,
02:50things can really hide and be hard to find.
02:53Approximately 2 billion neurons
02:55are dedicated to a dog's sense of smell.
02:58Okay.
02:58So I'm not really seeing much on this side.
03:00The turbinates look a little inflamed.
03:02I'm going up here again, just to make sure I don't...
03:05There's nothing I'm missing.
03:10There's, like, that.
03:12Huh.
03:14Yeah, I think maybe I should try and biopsy that.
03:16Oh, fun.
03:18Dr. Lauren spots what looks like a mass.
03:21Okay.
03:21Good.
03:22Yeah.
03:23I think it might just be goop, but...
03:24Oh, yeah.
03:25Oh, yeah.
03:26Oh, you've obtained the goop.
03:28Yeah, now we move the goop.
03:29Okay.
03:29Done with this part.
03:31There's no sign of a mass or a foreign object.
03:35In case there is a foreign body that I can't see,
03:37I just want to make sure we flush, flush, flush.
03:40Lauren gives the dog's nose a rinse,
03:42but it's likely Piper is just suffering from chronic inflammation.
03:47These complicated cases where you hit so many dead ends,
03:51there's no playbook.
03:53You just have to go with your gut
03:54and take a bit of a leap of faith.
03:57If she's clotting well, we can send her home.
04:00Okay.
04:02Okay.
04:09Let's go.
04:11Good boy.
04:13Let's go.
04:14Come, sir.
04:15Amal is desperate for someone to trust.
04:19Good morning.
04:20How can I help?
04:21I have an appointment.
04:22Her six-year-old chocolate lab, Socks, needs help.
04:26I'm just going to grab vitals,
04:28and then the doctor will come in and chat with you.
04:32Socks, it's my son and his wife's dog,
04:34so they bought him six years ago.
04:37We're all attached to him,
04:39and we can't live without him.
04:42Yeah, he's panting a lot.
04:45Yeah, he's warm.
04:4640.3.
04:48Hi, bud.
04:49It's been a month he's been sick on and off,
04:52so it's very hard what we're going through now.
04:56Socks has a mysterious fever.
04:58Despite multiple vet visits, its origin remains unsolved.
05:03We'll send the doctor in.
05:04Dr. Lauren is their final hope.
05:0740.3.
05:09Poor guy.
05:10I know what I feel like when I have a fever.
05:12My husband says I become intolerable.
05:16The body is just not meant to work at an elevated temperature,
05:19and in its most severe form,
05:21fever could lead to organ dysfunction and even death.
05:26Hello, hello.
05:27Thank you for seeing him on such a quick notice.
05:30Obviously I got the records,
05:32but tell me a little bit in your own words
05:33about kind of what's been going on.
05:35So a month or five weeks ago,
05:37he stopped eating.
05:38The fever was high,
05:39blood work showed high level of liver enzymes.
05:42She did put him on antibiotics.
05:45Right.
05:45And it worked.
05:46For two weeks he was feeling better.
05:48And then we're back at it again.
05:50Okay.
05:51He stopped eating.
05:52Okay.
05:53Antibiotic treatments have failed,
05:54and now Socks is barely eating.
05:57The last week it's been awful.
05:59Okay.
06:00To me, a fever is always urgent
06:02because usually when patients have fever,
06:05they're not eating or drinking.
06:06And worst case scenario is that Socks' fever
06:09is caused by something that we can't figure out in time
06:13to make a difference.
06:15She suggested, well, let's do an ultrasound.
06:17Yeah.
06:17The ultrasound came clear.
06:18He actually did have some changes on his ultrasound
06:21that I think weren't investigating.
06:25Dr. Loren spotted something on Socks' ultrasound
06:28that his other vets overlooked.
06:30Reading the report did give me a few clues.
06:34His liver was bright,
06:35and the lymph nodes that drained the liver
06:38were a bit enlarged.
06:39Those two things to me suggest that, like,
06:41the liver is where we need to look.
06:43What is he acting like right now?
06:46He never drank so much.
06:48Okay.
06:48Does he ever drink, like, standing water?
06:51Yeah.
06:52You've never found a tick on him or anything, have you?
06:54No.
06:55Okay.
06:55If Socks drinks standing water
06:58or spends time in a forest,
06:59there are certain infectious organisms
07:01like, for instance, leptospirosis
07:03or tick-borne disease
07:04that could definitely cause liver disease
07:07and even liver failure.
07:09Okay, Mr. Mann, we're gonna take care of you.
07:13Socks' fever is a mystery that can't wait.
07:15He needs to be admitted immediately.
07:19Hi.
07:20I know.
07:21You're a sad, sad boy.
07:23Sad, sad Socks.
07:27He's our family dog,
07:29so I'm hoping we get to the bottom of it.
07:32We can't live without him.
07:39Okay, here is what I think is going on in Socks' case.
07:43If we zero in on the liver,
07:45there are really three big categories of things
07:47that could be causing Socks' fever.
07:49infection, something like tick-borne disease,
07:53cancer, with lymphoma being a possibility,
07:56or the last category would be some of the more rare immune
08:00or inflammatory disorders,
08:02like copper storage disorder or hepatitis.
08:06Infection and cancer are at the top of my list,
08:09and we do have non-invasive ways to look for those.
08:12All right, brave boy.
08:13Which leg do you want?
08:15Socks is immediately sedated.
08:18Oh, no.
08:20Do you feel funny?
08:21First up is a non-invasive test
08:23to check for infection or cancer.
08:26Let's go.
08:27Good boy.
08:28Do you wanna lie down?
08:30I'm really hoping we can figure out what's going on
08:33with these non-invasive tests.
08:36If this test fails,
08:38the next step is a much more invasive surgical biopsy.
08:43Let's do the procedure.
08:45Okay.
08:45So, bile, liver.
08:48Dr. Augustin Marischal will perform the procedure.
08:52What is your suspicion?
08:53He could have hepatitis.
08:55I mean, he could have copper.
08:56He could have, like, infection.
08:58It could be anything.
09:00The fact that he has such a high fever
09:02really makes me lean towards something infectious.
09:04I would be surprised if we don't find anything
09:07on the cytology and culture.
09:09Go for it.
09:11First, Dr. Augustin takes a small sample
09:14of bile fluid produced by the liver
09:16to test for bacterial infection.
09:19Okay.
09:20Is it coming?
09:21Yeah.
09:22I'm really hoping I'm right
09:23and we don't have to put socks
09:25through a more invasive liver biopsy
09:27because I never want to make an animal
09:29go through more testing than they have to.
09:31Okay.
09:32I'm going to pull out now.
09:33Let's do the FNA.
09:35Next, he uses his ultrasound
09:37to gently guide a needle into the liver itself
09:40and remove a few cells.
09:47Good.
09:48Perfect.
09:49And you're done.
09:51With fever and not eating,
09:53we don't really have the luxury of time on our side,
09:56so it's really critical
09:57that we get socks as results quickly,
09:58and all I can hope is that we hit a bullseye
10:00right off the bat.
10:03Are you so steady, B?
10:08Canada West reception.
10:09This is Alicia speaking.
10:11Hi, Milo.
10:12Another patient has arrived
10:14who doesn't have the luxury of time.
10:17Five-year-old Labradoodle, Milo.
10:20Okay, you can come with me.
10:22Okay, great.
10:23Owners Sonia and Rami are here today,
10:25along with their daughter, Samur.
10:28You're so anxious.
10:32Milo is just amazing.
10:34Whatever we do, he's part of it.
10:35When we are watching a movie,
10:36he's sitting with us.
10:38When we go out, he wants to go for a walk with us.
10:41He's part of the family, yes.
10:44Hi, Milo.
10:45I'm just going to grab some vitals,
10:46and then the doctor will come in and chat.
10:49Ever since we got him, he has had health problems.
10:52He poops bad.
10:53He vomits.
10:55We took him to the vet about 30, 40 times.
10:58It's very frustrating.
11:00Obviously, we were very emotionally attached to him.
11:03When he's sad, we're all sad.
11:05That's the way it goes in our house.
11:06Done.
11:07There we go.
11:07All done. Freedom.
11:08Goodness.
11:09All right.
11:10We'll send the doctor in and chat.
11:16Hello.
11:17Got everybody here.
11:18I'm Dr. Edelman.
11:19And you must be Milo.
11:20Yes.
11:21Hi, Milo.
11:21You look like you got your hair done just for this appointment.
11:25All of us did.
11:27Hi, sweetie.
11:28I know.
11:28Are you a little anxious here?
11:30Yes.
11:30Yeah, I figured as much with all of his issues going on.
11:35So, tell me a little bit about his past and just kind of...
11:38Yeah, he suddenly developed diarrhea.
11:41Sometime he threw up blood.
11:43Sometime in the poop.
11:45He like a lot of blood and mucus.
11:47Sometime black.
11:48Sometime he doesn't eat.
11:49Okay.
11:50Yeah.
11:50If Milo keeps going on the trajectory that he's going, with all the blood that he's vomiting
11:54up, that could be life threatening for him.
11:56And then usually he was treated with some combination of like an anti-nausea medication.
12:01Metronidazole usually always.
12:03Yeah, always.
12:03A dog being on antibiotics that many times is definitely a red flag for me, especially
12:10with a dog this young.
12:11But generally, he seemed to respond pretty quickly, like would get better.
12:15Yeah.
12:16But he suddenly developed these symptoms, throwing up blood.
12:20After finishing his treatment, Milo's symptoms always came back.
12:24And after that, I think he found out like he has an acid in his stomach.
12:29Yeah.
12:29I think more than three months he's on the medication of acid.
12:33Okay.
12:34Treating Milo with a drug for acid reflux has also failed.
12:39Milo's owners are obviously very dedicated.
12:41They've been back and forth to the vet so many times, and I just feel terrible that they're
12:46still in this position.
12:48There's something we're missing.
12:50And I will say, I knew he was going to be a doodle because these dogs are hypoallergenic.
12:56They don't shed.
12:57Yeah.
12:58They don't tend to cause allergies in people.
13:00They themselves tend to be quite allergic dogs, and they tend to have a lot more GI issues.
13:07So based on his history alone, like I can tell that he has food allergies.
13:13So the first thing would be to try him on a different diet to see if maybe it's just that
13:19he does have food allergies that we're not controlling well enough.
13:22A change in diet doesn't really sound like a lot.
13:26It's one of the few things that we haven't tried yet.
13:28But to be honest, I'm not really sure if it's going to work.
13:32Everybody loves him a lot.
13:34Is he going to be okay, right?
13:35I honestly don't know yet.
13:37But I think it's good that you're here now because going in and out of the hospital for
13:42diarrhea and vomiting every month is not a way for him to live his life.
13:52Canada West Reception, this is Sassara.
13:54That dog needs .5 bills.
13:56You're not going to run away, okay?
13:58Yeah.
13:59So we're just going to go check on Socks.
14:01We found you!
14:02The next day...
14:04Hi, Socks.
14:05The mysterious fever is taking its toll.
14:08Six-year-old Chocolate Lab Socks is getting worse.
14:13Whatever's causing his fever is really progressive at this point.
14:17And that's concerning.
14:18Oh, sweet boy.
14:20Results have come back, but we still don't know the cause.
14:23I'm a little bit surprised and also a bit disappointed because this means that I have to keep digging.
14:29Oh.
14:31Oh, thank you.
14:34Okay.
14:35The test results eliminated the top two theories on my list.
14:38There was no sign of infection or cancer.
14:42That leaves just these very rare disorders, hepatitis or copper storage disease.
14:47But testing for those requires a much more invasive test, a surgical liver biopsy.
14:55A part of me is thinking, well, fever really isn't a common sign for things like copper storage disease or
15:03chronic hepatitis.
15:04But at the same time, like all points are leading to the liver in his case.
15:08I don't really have anything else to focus on.
15:14Hello?
15:15Hi.
15:16It's Dr. Edelman calling from Canada.
15:18Oh, hi, Dr. Edelman.
15:20Hi.
15:20So I just wanted to go over the results from yesterday.
15:23Basically, what we've ruled it down to would be some sort of chronic hepatitis or copper storage disease.
15:31And so he needs a liver biopsy.
15:34I just have to trust my gut here and go with what makes the most sense to me and hope
15:38I'm right.
15:39He's not eating.
15:40That could be very life-threatening.
15:42I don't really think we have another choice.
15:45There is no other way than a full biopsy.
15:49Yes.
15:49Without a biopsy, we don't really know how to treat him.
15:54We need to do this as soon as possible.
15:56Okay, let's do the biopsy.
16:02Are you coming to see internal medicine for today?
16:04You left.
16:05I'll remove and tuck.
16:07Does she want half-strength saline or does she want plasmoly?
16:11Oh, it's okay, Luna.
16:12I know.
16:15Doesn't have a mean bone in her body?
16:17Just anxiety.
16:17Yeah.
16:18Dr. Lauren has a new patient and a new mystery to solve, this time in a tiny package.
16:25We've been to our vet about 10, 12 times in the past few months.
16:30Alex has exhausted her options trying to get help for her senior dog, Luna.
16:36See?
16:36Doesn't hurt.
16:38She's had two x-rays, a ultrasound, a CT scan.
16:43They couldn't figure out what was going on, so they sent us here.
16:47Now 12 years old, Luna has been by Alex's side through the lows of infertility, and then
16:54the joys of having a baby.
16:56We've been through some, like, trying times the last couple years.
17:00We dealt with infertility.
17:02I couldn't have got through it without her.
17:05We're always close, but I think going through that, she knew.
17:09She used to sleep just completely attached to me, like, while I was pregnant.
17:14She seems to know when I need her.
17:18My daughter.
17:19She calls her chicken, because she thinks she looks like a chicken.
17:23Luna is her favorite thing.
17:25She just stole my heart.
17:28Hi.
17:29Hi.
17:29I'm Dr. Edelman.
17:30Hi, I'm Alex.
17:31Hi.
17:32It's so nice to meet you.
17:33Nice to meet you.
17:33This is Luna.
17:34Hi, Luna.
17:35Hi.
17:35Oh, sweet girl.
17:36I saw the referral come in.
17:37I looked at it.
17:38I was like, yeah, she needs to be seen.
17:39Yeah, there's been a lot of appointments and...
17:42A lot of testing.
17:43A lot of testing done lately, yeah.
17:45She was having one infection after the other, and they treated her for pneumonia.
17:49And then the last couple months, the cough started.
17:53Oops.
17:54Is that kind of the cough?
17:55Yes, but louder.
17:56Very louder, okay.
17:58Luna is suffering from a severe cough.
18:00It could lead to respiratory distress and could be life-threatening for her.
18:05Her lymph nodes are hot.
18:06Mm-hmm.
18:07Like, really big.
18:09But right away, Dr. Lauren notices something even more sinister.
18:15So it's not just her submandibulars that are big.
18:17So she, her prescapular lymph nodes, which are right in front of her shoulders, are also big.
18:21All of Luna's lymph nodes are enlarged.
18:24Certain types of lymphoma could definitely explain a cough.
18:29You also mentioned some kind of behavioral changes.
18:32Well, she is 12.
18:33Okay.
18:34But usually she's, you know, the fastest dog on the beach.
18:36But just really slowed down.
18:38Poor girl.
18:39Yeah.
18:40It's just sad just seeing her decline.
18:45Has she ever been anywhere outside of BC?
18:47Just Seattle.
18:48Just Seattle.
18:49Okay.
18:49But that was years ago.
18:50In the absence of any previous travel history, this is lymphoma until proven otherwise.
19:00First thing that we worry about is some type of cancer.
19:06My concern is if it is lymphoma is how we explain it to my daughter.
19:10That would be the worst case scenario.
19:13The first thing that I would absolutely recommend that we repeat are lymph node aspirates.
19:19Because that's definitely not something we want to miss.
19:21Okay.
19:22Okay.
19:24Okay.
19:26Good girl.
19:27Even though I know it doesn't feel like it.
19:31It's okay, my love.
19:33Ready for stabs.
19:35Dr. Lauren immediately orders a test on Luna's lymph nodes to look for signs of cancer,
19:41which could explain both her cough and enlarged lymph nodes.
19:45You're such a good girl.
19:47Certain types of lymphoma could definitely explain a cough.
19:51More of the, like, large cell aggressive lymphomas.
19:55Okay, my love.
19:56We're gonna start up here with these big honkers.
19:59These massive things.
20:01There's not many things that would cause lymph nodes to be that big,
20:04and for all of them to be that big.
20:06Good girl.
20:10Unless the dog came from somewhere like Mexico, where there's a lot of tick-borne disease.
20:16Yeah, it's okay.
20:17Good.
20:20Look how chunky that is.
20:22Whoa.
20:23That's wild.
20:25Hopefully this is the only time we gotta do this, so.
20:27The samples will be sent to the on-site lab for analysis,
20:31and they should have results within 24 hours.
20:35Okay, good job. You did great.
20:47Okay, are they in my inbox?
20:49Okay, sweet. Thanks.
20:51Okay.
20:52Looks like Danica just emailed me some pictures from Milo's mom.
20:57Four-year-old Milo was started on a hypoallergenic diet
21:01in a last-ditch effort to control his diarrhea and vomiting.
21:06Whoa.
21:08But there's bad news.
21:09Oh, yeah.
21:10That's actually way worse than I thought it was gonna be.
21:14I mean, I get a lot of poop pictures, and this is pretty bloody.
21:18And so is the vomit, actually.
21:20He's clearly failing his diet trial.
21:22I was hoping that that would be all that he would need.
21:25The mystery in Milo's case keeps getting deeper.
21:31I can tell from his records that he's already been treated
21:34with pretty much every antibiotic possible,
21:36so I really don't think it's a bacterial infection.
21:39My top theory was that he has really severe food allergies,
21:43but failing this diet trial means I have to cross that one off as well.
21:48I really don't know what else could be going on.
21:52This is no joke.
21:54Milo's violent episodes could cause
21:57life-threatening ulceration or bleeding.
22:00Okay, we're off.
22:02Dr. Lauren needs a new plan.
22:07Hi.
22:08Hi.
22:09How can I help you?
22:10I'm actually looking for a blender.
22:13Yeah, we got one here.
22:14I need it to blend, so I think that...
22:16I think it's gonna work for what I need,
22:18so, yeah, I'll take that.
22:19Okay, for sure.
22:21Dr. Lauren wants to try an experimental new treatment.
22:25There's not an algorithm to follow in a lot of these cases,
22:28and so you do have to get creative and think outside the box.
22:32Thanks.
22:42Hi, good morning.
22:44Yes, who's a good dog?
22:45Okay.
22:46Six-year-old chocolate lab Sox is about to go under the knife.
22:50Sox is gonna have a laparoscopic liver biopsy, so it's a way that we can get a number of samples
22:56from the liver.
22:57Dr. Michael King, a veterinary surgeon, will perform the procedure.
23:02I'm putting a dog who has a fever, who's already not feeling well, under anesthesia to get a biopsy, who's
23:08then gonna have to recover from that.
23:10And if I'm wrong about this, that's a lot to put him through.
23:14Under anesthesia for an hour and a half, two hours total with that.
23:18Here's why Sox is going under.
23:20I've eliminated everything except hepatitis and copper storage disease.
23:24Testing both of those requires a liver biopsy.
23:27If I'm right, this is what we have to do to save Sox's life.
23:33How we doing?
23:36Come up that side.
23:37That all looks good.
23:38That's colon.
23:39There.
23:41That's the liver.
23:42Yep.
23:43A liver biopsy is when they're getting a piece of tissue from the liver.
23:48And then twist and pull.
23:50Definitely ease it out onto the side there.
23:52Good.
23:53Often multiple small pieces from different liver lobes, so we have a representative sample.
23:59Those are the left lateral.
24:01This is left medial.
24:02The biggest risk of a biopsy procedure is that it could cause the patient to bleed out.
24:08I think we've got pretty good samples there.
24:10All right.
24:11So now I'm just going to double check the bleeding situation.
24:14You can see the bleeding there.
24:15That looks very normal.
24:16It's colliding really nicely.
24:17I'm happy with that.
24:18Okay, good.
24:20The samples will be sent to a specialty lab to be tested for multiple rare conditions.
24:26Hey, Lauren.
24:27Hey, how did it go?
24:28I think it went pretty well.
24:29There was nothing about a specific area that looked really concerning.
24:32I've got samples for you for culture.
24:33Same with copper.
24:34Two, if not three, biopsies from each lobe in those for histology as well.
24:38Great.
24:39And then, like, bleeding ones?
24:40No, we're going to keep overnight just to make sure.
24:43Socks will spend the night in ICU, watched around the clock for any sign of bleeding or decline.
24:49The samples have been acquired.
24:51The surgery went really well, but the next 24 hours will be critical to his recovery.
24:56He's staying overnight under surgery's care.
24:58Excellent.
25:00So I really hope we find something, and with that I hope it's something that we can treat,
25:04because Socks' quality of life right now is not good, and it's really only getting worse.
25:10Oh, you're so sleepy.
25:18Hello.
25:19We're here for Socks.
25:21The next day, Amal and her son, Chris, are on pins and needles.
25:26Well, where is it?
25:26You have a seat held here, Charlie.
25:27Okay, thank you.
25:29Socks has recovered from his surgery enough to go home, but his test results could take days.
25:36Oh, you're so hot.
25:38Mm-hmm.
25:38And in the meantime, he's still suffering from the mysterious fever.
25:44Yesterday was very stressful.
25:46You know, I was worried.
25:48I didn't know what would happen.
25:49So once the surgery was done, the doctor's score was such a relief.
25:54So now we're doing much better, but still there's no results yet, so we don't know.
26:00We're used to having him around and being joyful and such, but unfortunately it's not at that stage right now.
26:13Socks' symptoms are not super typical.
26:16He's not really fitting into any box.
26:18We'll have a recheck with Dr. Edelman and then the sutures will be removed if everything looks like it's healing
26:22well.
26:24If nothing shows up on the liver biopsy, Dr. Lauren has little else to go on.
26:30You want to go home?
26:32Worst case scenario, Socks' fever is caused by something life-threatening and we can't figure it out in time to
26:39help him.
26:40Let's go.
26:48Come on. Good job. Milo.
26:51Four-year-old Milo is back at the hospital.
26:53He's really sick, severe diarrhea with blood, not eating.
26:58He has big feelings.
27:04Other vets have tried every treatment under the sun, but nothing has worked.
27:09Good boy.
27:10Dr. Lauren has a new idea, but it's very unorthodox.
27:16Some exciting stuff here.
27:18Just blend in poop.
27:20Danica and Cassandra are prepping outside as a courtesy to other hospital staff.
27:27It's called a fecal microbial transplant or FMT.
27:30I just kind of dump it in.
27:32We are replacing the patient's own microflora, the combination of bacteria that make up their gut, with a donor sample
27:41that contains a healthier version of that.
27:43You know what? I'm going to put my watch in my pocket.
27:45That's smart.
27:46During a fecal transplant, poop from a healthy dog is blended with saline and transplanted into the patient.
27:54You'll never look at grain smoothies the same.
27:57You're welcome.
27:59One of the biggest risks with a fecal transplant is if you're not using donor feces that has been screened
28:05properly, you could be introducing other infections.
28:09Cassie, do you want to glove up and hold this?
28:12That's why you don't just take any dog's poop and you have to do regular screening.
28:17Poop from a healthy dog contains billions of good bacteria, something Milo might desperately need.
28:25So, here's my theory about Milo's mystery.
28:28Maybe he does have food allergies, but he failed the diet trial because that's not the only thing going on.
28:35On top of the food allergies, all the antibiotics that he received as a puppy could have thrown the balance
28:41of good bacteria in his gut out of whack.
28:45Fecal transplant has been proven successful in humans at restoring that balance.
28:50So, in theory, it should also work in vet med.
28:54Come on.
28:56Here's the beast.
28:57While Danica and Cassandra finish prep for Milo's procedure.
29:02So, I just got back Luna's results from her lymph node aspirates.
29:08The lab has sent over Luna's test results.
29:11These findings are diagnostic for T-zone lymphoma.
29:15This is actually really good news for Luna because it is probably the best lymphoma you can possibly have.
29:21The type of lymphoma she has isn't life-threatening and tends to be asymptomatic.
29:28Here's why Luna's results are so surprising.
29:31She has a cough and swollen lymph nodes.
29:33There are some aggressive lymphomas that could explain both of those symptoms.
29:37But the type of lymphoma that Luna has wouldn't cause a cough.
29:41And in fact, it probably wouldn't even need treatment.
29:46So, the good news is that we finally diagnosed the lymphoma.
29:49But the bad news is that it may not actually be responsible for the signs that the owner's bringing her
29:54in for.
29:55This definitely makes Luna's case a lot more complicated because we'll have to go back to the drawing board.
30:05Can you pass me the clippers?
30:06So, we're just going to pop on the scale.
30:08Oh, no, it's okay.
30:12Look at that face.
30:13He's stoned.
30:15Back in internal medicine...
30:17I'm just here for the supervision.
30:19I don't actually have to get dirty.
30:22Milo is about to undergo his fecal transplant.
30:25Okay, Milo.
30:30You ready?
30:31Yeah.
30:32We're basically giving an enema with poop.
30:36Oh, yes.
30:37I'm here for the moral support.
30:38I get the nice end of the dog.
30:40The not poopy end.
30:43Feels funny, right?
30:46His tail.
30:47You're wagging your tail.
30:48I know, Milo.
30:49Good boy.
30:50I know.
30:51You're almost done.
30:51I'm sorry.
30:53Maybe just poopy will make you feel better.
30:56That's pretty good.
30:57All right.
30:57Okay.
30:58Done.
30:59Good job, honey.
31:01Whoa.
31:02That was weird, wasn't it?
31:04Then you get to go sit and relax all day with your new poop in your belly.
31:11Now, for the procedure to be effective, it's critical that the donated sample stays in place.
31:18We don't walk him.
31:19We don't feed him throughout the day.
31:21We just want him to kind of chill and not move.
31:23But we just want that to sit there and try and kind of create a new environment in his gut
31:28that will hopefully be better than the crappy one that he currently has.
31:35Okay, Milo, no pooping.
31:44Okay.
31:44Hi, Socks.
31:45All right, we can go this way.
31:47It's been a few days since Socks' liver biopsy.
31:51Oh, who's so clever?
31:52Oh, he lost weight.
31:55His owners, Chris and Amal, are back.
31:57This time, hoping for answers.
32:00Look, you're gonna take your blood pressure.
32:03Socks is still suffering from an unexplained fever.
32:07We're a bit anxious to see what the results will come out.
32:11My main, main concern is finding out he has something that I cannot cure.
32:17I have some results to give the owner, which I'm kind of excited about.
32:21The results are very unusual.
32:26Hi.
32:27Hi, buddy.
32:27So yeah, so I got back his results.
32:30It is a form of chronic hepatitis.
32:32After countless tests came up empty, Socks' biopsy finally revealed the answer.
32:39Chronic hepatitis is kind of this umbrella term, and in Labradors, it's genetic.
32:44But it's just weird, like, chronic hepatitis dogs don't normally have such a high fever.
32:48Yeah.
32:48But with this particular rare form of chronic hepatitis, they do.
32:53So is it a better version of the chronic hepatitis?
32:57Yeah.
32:57It can have a very good prognosis if identified early and treated appropriately.
33:02Awesome.
33:02To find this answer was really great.
33:06I mean, we were worried it was copper, it was major chronic hepatitis.
33:11We didn't know at what stage.
33:13So getting these results were a relief.
33:16The treatment is suppressing the immune system, which is the same as for our other form of chronic hepatitis.
33:23Now, what we're looking for in an ideal scenario is both a clinical remission, meaning he's free of clinical signs,
33:29like, no fever, eating well, happy.
33:32And also, ideally, to have his blood work be normal.
33:36It's gonna be all his life.
33:38Yeah.
33:39Because you guys were so diligent and committed to his workup, we got it.
33:42So we caught it.
33:44You caught it.
33:44Yeah.
33:45That's great.
33:47Socks is not only a family dog, like, it's everybody's dog.
33:51It's friends' dog, people we walk with in the forest.
33:54So we had non-stop calls, texts.
33:57He's a popular dog.
34:00The result came out great at the end of the day.
34:04The doctors have been great here.
34:06I think we're pretty relieved, yeah.
34:07We're happy, yeah.
34:08We're happy.
34:18Is she feeling calmer?
34:20Calmer.
34:21Still shaky.
34:22Back in internal medicine, Danica and Cassandra are prepping Luna for sedation.
34:27I'm gonna stick this on a leg.
34:29Maybe a print leg.
34:31Dr. Lauren still hasn't solved the mystery of Luna's strange cough.
34:35Luna's cough is really bad, and it's really important that we figure out the cause because it could be life
34:41-threatening for her.
34:42Luna has a rare form of cancer, but in a twist of fate, it's not what's causing her cough.
34:50Luna's lymphoma explains her swollen lymph nodes.
34:53So if we take those out of the picture, solving her cough means focusing in on her airways and lungs.
35:00So what I want to do is bronchoscopy, going down her airways with a camera and sampling.
35:08She's already getting pre-oxygenated.
35:10Okay.
35:12But bronchoscopy, especially in small dogs, is a high-risk procedure.
35:17It's probably one of my least favorite scoping procedures to do just because we don't have a secured airway during
35:23the procedure.
35:24Basically, we can't intubate her, so it's kind of, it's scarier.
35:28Inserting her camera deep into Luna's lungs will temporarily choke her air supply.
35:34We're just gonna be going straight into her airway.
35:36I'm gonna go in with my scope, take a quick look around.
35:39The procedure also requires filling Luna's lungs with fluid.
35:44Be prepared to have to intubate her between...
35:46Oh, I have like seven tubes.
35:47Okay, because we might have to like intubate and then pull out.
35:49When we start putting scopes into the airways and then flushing fluid into the airways,
35:54we can definitely cause patients to decompensate.
35:57This is the map of the airways that we kind of follow,
35:59because you'll see it's like a bit of a maze.
36:02And these are the hardest lung lopes to get into.
36:05This is my most stressful procedure.
36:06Oh, yeah.
36:07I hate bronchoscopies in little dogs.
36:09I don't know how many thousands of scopes I've done now.
36:12The only ones where I have had a patient die on the table have been bronchoscopies.
36:18It's potentially life or death for this patient.
36:21She's oxygenating well to start, 100%.
36:25All eyes on Danica.
36:28Danica will monitor Luna's oxygen levels while they insert a camera into Luna's lungs
36:33and hunt for the cause of her life-threatening cough.
36:36I mean, she actually has the hardest job.
36:38Trust is so important when it comes to team dynamics and patient care.
36:43It's really important that we have each other's backs.
36:48So that pulse box there that says 100%, we're going to be looking at that,
36:51because when I'm in there and I start washing, it's going to start to drop.
36:54The procedure requires flooding Luna's lungs.
36:57Go ahead.
36:57Briefly drowning her.
36:59Okay.
37:00Ready?
37:00Ready.
37:03It just needs it to...
37:05Okay, so there's our main opening, two main openings.
37:08And then I'm going to try and get in that little hole there.
37:11Okay, we're in.
37:12Okay, let's wash in here.
37:14As soon as she reaches the lungs, Dr. Lauren quickly injects a small amount of saline.
37:19Coupage, coupage, coupage.
37:21Danica thumps on Luna's chest to shake the liquid in her lungs.
37:25Now suction.
37:26Come out.
37:27Air out.
37:28Yep.
37:29They remove the fluid.
37:31Yeah, let's see.
37:32It's cloudy.
37:33Hoping they've collected samples of tissue and any bacteria or viruses that might be causing
37:39her cough.
37:40Doing great, Luna.
37:42She's still very, very pink.
37:45Dr. Lauren needs at least four samples.
37:48My biggest concern is where oxygen levels, because I want to make sure that they're not
37:52dropping as I'm in there.
37:54What's our pulse locks at?
37:55Still 100.
37:56Okay.
37:58Okay, one more time.
38:00I want to get my samples and I want to be able to get a result for these owners, but
38:04if
38:05the patient's oxygen levels are dropping and we need to intubate, the procedure's done.
38:10Okay, this is the harder side.
38:14I stole their stuff again.
38:22Oh, come on, there's like chunkies there.
38:24I know it.
38:31You doing okay, Danica?
38:34You want to intubate?
38:35Luna's oxygen levels are dropping.
38:38No.
38:38Go for it.
38:39Just get her done.
38:41She's at least pink in the 90s.
38:43Just keep going.
38:45Dr. Lauren still needs one more sample.
38:49Come out.
38:50Come on.
38:50Just don't lose it.
38:52Yeah.
38:52Okay, I'm just going to take a quick peek if we're still okay.
38:55Yeah.
38:56I'm done.
38:57Okay, now Danica's going to intubate her just so we have an airway secured during recovery.
39:03Samples are safely stored.
39:05Lovely.
39:06Good job, Luna.
39:08Mm-hmm.
39:09Luna did awesome during her procedure despite me being very nervous.
39:12So I'm going to put that in my pocket as like the one to think about the next time I
39:16have it so I don't get so nervous.
39:21Good job, Luna.
39:22Good job, everyone.
39:34We're just going to keep him in the room where he's nice and calm before we bring him to you
39:37guys because we want to try and prevent him pooping before he goes home.
39:43After a successful fecal transplant procedure, Milo's family is here to pick him up.
39:49The look of disappointment when I don't come in with Milo.
39:52You're like, oh.
39:53So everything went really well.
39:56We gave him just like a little anti-anxiety med to take the edge off while we were doing the
40:00procedure, but he tolerated it really well.
40:02Even like his tail was wagging while we were giving him the, like the enema.
40:06It was very cute.
40:07The actual procedure itself generally has very minimal side effects.
40:12Any time you introduce something into a patient that's not theirs, whether it be blood or poop, they could have
40:18a reaction to it.
40:19We can see like a mild fever.
40:22And then in terms of knowing how it works, we just have to kind of wait and see, you know,
40:26is he going to have another episode really?
40:28Hopefully he gets better.
40:30Yeah, yeah.
40:31Okay, well we'll go get your boy.
40:33It could take weeks or months to know if the transplant was effective.
40:39Hey.
40:43Aw.
40:45Aw.
40:46Are you so happy?
40:50Okay.
40:51We'll be in touch.
40:52Okay.
40:53All we could really do at this point is wait and hope we found the answer.
40:57Let's go Milo.
41:08Let's see.
41:09So she's a little drunk.
41:11Luna is already starting to bounce back.
41:14Luna, do you want to go home?
41:16She seems awake enough.
41:19Luna's family put everything on the line, betting on Dr. Lauren and a risky procedure to solve the mystery of
41:27Luna's cough.
41:29People are putting these pets and trusting them in your hands.
41:34It's a lot of responsibility.
41:37You ready to go home?
41:38You want to see your mama?
41:39She'll be happier with her mama.
41:41Yeah.
41:41With the senior dogs, we want them in and out.
41:45They're trusting me to solve the mystery, so when they agree to do a high risk procedure, they're clearly hoping
41:52it's going to help find the answer.
41:57Hi.
41:58Hi.
41:58How are you?
41:59She's definitely a little bit stoned.
42:03Really hoping she's okay for her sake, for our sake.
42:07So hopefully it is something treatable.
42:09Got back Luna's cytology results.
42:12There wasn't any evidence of any cancerous cells.
42:15There was no evidence of overwhelming infection.
42:17You really just saw like very mild inflammation.
42:20It's good news for Luna.
42:22Her bronchoscopy identified the cause of her cough as inflammation, a treatable condition.
42:27Most of the time, these inflammatory disorders, particularly in small dogs, are kind of genetic conditions.
42:33The openings to her airways, particularly in those front lung lobes, were kind of collapsed a bit.
42:38Okay.
42:38And so what I'm going to treat her with is a steroid to try and decrease that inflammation.
42:43It can take one to two weeks to see the full effect of the inhaler.
42:47And you're going to be home with her.
42:48I think that we're fine to set her home.
42:50Yeah.
42:50Thank you so much.
42:51You're welcome.
42:52Okay.
42:53I'm going to go home.
42:54Luna's lymphoma doesn't require treatment.
42:56And for her cough, she'll be given an inhaled steroid.
43:00The treatment is safe.
43:02And even at her age, I'm hopeful she'll make a full recovery.
43:05Good girl.
43:06When a pet owner puts their trust in me to do a high risk procedure, and in the end it
43:13does
43:13make the difference, that trust means the world to me.
43:19Go here.
43:20Go Milo.
43:21Go Milo.
43:22Go Milo.
43:22Go.
43:23Across town, another patient is also doing great.
43:26Good job, Milo.
43:28After his owner trusted Dr. Lauren with an experimental new treatment.
43:33Milo is doing fantastic.
43:35The fecal transplant made a huge difference for him.
43:40His disease is very responsive to, you know, reestablishing his normal healthy gut microbiome,
43:48and that's definitely the path that we're going to continue on moving forward for him.
43:52The mood of the house is different now.
43:55When he's happy, we are all happy.
43:57He's made our life much, much better.
44:00We'll come back after hearing diet.
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44:03We'll okay go.
44:03And we'll see that people say that if he's ever prepared for him.
44:04We'll come back with you and we'll see questions.
44:04We'll see if the final newsesta interrupts.
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