- 2 weeks ago
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00:02Something happened.
00:02We found something abnormal.
00:04It's OK.
00:05Leah's scar fluid in her chest.
00:06She was having trouble breathing.
00:08She's kind of a ticking time bomb.
00:09We will solve your mystery.
00:11He's lost so much muscle.
00:13Oh, I know.
00:15With Ruth, we're seeing heart enlargement.
00:17There's something going on.
00:19Yeah, this is crazy.
00:20Probably been to the vet 15 times.
00:22I saw her deteriorate.
00:23She just wasn't herself.
00:25In Hazel's case, I don't want to wait too long.
00:27I don't think we have the luxury of time.
00:29This is the last option.
00:31We need to figure out what we're dealing with fast.
00:34Come on, baby girl.
00:35If I'm treated, she could die.
00:44We'll pop up on the scale here.
00:47Good.
00:48Sit.
00:48Cool.
00:49We're done with the ultrasound.
00:50Let's do the procedure.
00:54Stay.
00:55Normally, urethra would start way down here.
00:57Yeah.
00:58But we think that's to be through there.
00:59Yeah, exactly.
01:00When pets are in crisis, Canada West Vet Hospital is their best chance.
01:06I am going to go.
01:07And the toughest mysteries are tackled by internal medicine specialist Dr. Lauren Adelman.
01:13Let's pray that this is quick.
01:14This morning, a new emergency case came in.
01:18Five-year-old Husky, Onlai.
01:21His stomach looks kind of sad.
01:23A little angry.
01:24When I came in, I saw a note that he had been through emergency over the weekend for vomiting,
01:29inappetence and diarrhea.
01:31Onlai had started to improve and was sent home.
01:34Let's do, what do you have?
01:35Yeah.
01:36But today, his owners brought him back.
01:39The owners just could tell something was wrong.
01:43Where are you?
01:45His owner's hunches were right because we decided to do an ultrasound and there's clearly something
01:51in his stomach that shouldn't be there.
01:54Oh, I don't know what that is, but it's really trying to get down the hyalurus there.
01:59Whatever's in his stomach looks like it's causing a blockage right at the entrance to the small intestine.
02:05Definitely looks like fabric.
02:07Yeah.
02:08If you look really close.
02:09They have a toddler, so who knows?
02:11If we don't address that immediately, it could become life-threatening very quickly.
02:16Okay, open.
02:17Open.
02:18Let's see.
02:19Grab.
02:20Grab.
02:20Oh, squishy.
02:22Okay.
02:23Hold on.
02:25Oh.
02:26Whoa.
02:26That was a nice birthing.
02:29That was a birthing.
02:30It was.
02:30Trust me, I've given birth.
02:34It's a baby sock.
02:36It's a baby sock.
02:36It's a baby sock.
02:39It was the toddler.
02:40Toddlers.
02:41Oh my God, it's so cute.
02:44As veterinarians, it's really important for us to trust the intuition of our clients in
02:49understanding they know their pets best.
02:52Maybe it's not a buck.
02:54Maybe it's part of a toy.
02:55It looks like a zebra foot.
02:58See?
02:59Doesn't it look like a zebra paw?
03:01It's not a baby sock after all.
03:03It's a little tiny paw.
03:04I scoped a zebra out of a dog today.
03:07If they're telling us they think something's wrong, you know, we have to believe them.
03:12Hi.
03:13You want to go home?
03:16I'm going to call Dad, give him the good news.
03:18Okay.
03:19Good job, team.
03:25Someone's excited.
03:27Okay.
03:28Not all pet mysteries are solved so easily.
03:32David is also convinced that something is very wrong with his five-year-old pit bull.
03:39Come here.
03:39Sit, please.
03:40Shh.
03:41You're okay.
03:42Yeah, I know.
03:43David adopted Bruce Wayne at eight weeks and named him for the bat-shaped mark on his chest.
03:49All right.
03:50We're going to go this way.
03:51Hi, my love.
03:52All right.
03:53Bruce Wayne was a puppy.
03:55He was built like a bodybuilder.
03:57We'll just pop into this room here.
04:00I think the name kind of picked him.
04:01Dr. Edelman will be in in a few minutes.
04:04He's five years old.
04:06Apparently someone else got their birthday gift.
04:08Oh, Bruce.
04:09He's a very happy dog.
04:12Hello, hello.
04:13Hi.
04:13I'm Dr. Edelman.
04:15Hi, bud.
04:15Hi.
04:16You're very cute.
04:17Whatever the issue is, hopefully it's manageable.
04:20So, I got the referral from your vet and it was just like very like kind of playing things down.
04:26You were pretty concerned about what was going on.
04:29Correct.
04:30David's family vet assessed Bruce Wayne, but downplayed the problems David has been seeing.
04:36He's lost so much muscle around his neck, his head, his shoulders, everything.
04:41And he's always been a very muscular dog.
04:45Bruce Wayne's muscle loss is less obvious to those who don't know him.
04:49Just looking at him from across the room, I'm like, oh yeah.
04:52He looks okay.
04:52He looks okay.
04:53Yeah.
04:54When I first see Bruce Wayne, he looks pretty well muscled to me.
04:59If I showed you a photo, you see how round his shoulders are now?
05:02Yeah.
05:03But even a few months ago, he looked like a different dog.
05:07It doesn't feel like the same dog you've been petting for four years.
05:10Yeah, I can definitely see the difference there.
05:13Muscle wasting could be an indicator of some sort of underlying more serious disease.
05:19Typically when we go to the park, he would run around and play with dogs.
05:22He hasn't done that in like a month.
05:25Okay.
05:25Dr. Loren suspects Bruce could be showing early symptoms of a life-threatening condition.
05:31The difficulty is that muscle wasting is such a nonspecific sign.
05:35So tell me about his diet.
05:36Like what's he eating right now?
05:39Yeah, it's a grain-free one.
05:42Bruce Wayne's grain-free diet may be a clue.
05:45With the whole trend in grain-free, what's happened is a lot of dog breeds are now getting heart disease.
05:51Sometimes what we can see is muscle loss with that condition.
05:55Heart disease caused by a grain-free diet is just one of many deadly possibilities on Dr. Loren's list.
06:02As an owner, if you feel like something's wrong and you don't follow your gut, you could be regretting that
06:07more than anything.
06:09Aw, that's so sweet.
06:11Pet on your shoulder?
06:12Yeah.
06:13Maybe a bit neurotic, but what would you not do to save your pet?
06:17We're just going to have to stay here for the rest of the day.
06:19Yeah, yeah, yeah.
06:19See you guys.
06:21There's nothing that's really jumping out from my physical exam, so we probably need to do some pretty thorough testing.
06:27Okay.
06:28Well, we will solve your mystery.
06:30It may take some time, Bruce Wayne.
06:33I've just been trying to do what I think is the right thing.
06:36Okay, Bruce.
06:36Come with me.
06:37Good boy.
06:45Muscle wasting can be a symptom of a huge spectrum of conditions.
06:49Arthritis, heart disease, as well as hormonal problems with things like thyroid disease or cancer.
06:57Let's go.
06:58Come on.
06:59To rule out issues like a thyroid hormone imbalance...
07:03Okay, this way. Good job.
07:04Dr. Loren is starting with a blood test.
07:07Bruce, come lay down here.
07:09Mm-hmm.
07:10It's better if you don't look.
07:11You seem cold.
07:12I'm sorry.
07:13But that's just the first of many tests for Bruce Wayne.
07:18Good boy, Brucey.
07:24I want to do a chest x-ray to make sure there's no evidence of heart disease.
07:31It's a bit of a chunky heart.
07:32He's been on a grain-free diet.
07:34Bruce Wayne's grain-free diet isn't the only suspect in his muscle loss.
07:40That spleen is a bit generous to me.
07:44Because Bruce Wayne's spleen looked a little bit abnormal, I want to take a sample of it to rule out
07:49a cancerous process.
07:53It's also a cruel joint. It's a bit buffy.
07:56Inflammation in Bruce Wayne's joints could also signal that arthritis is the culprit.
08:02I want to do joint taps on Bruce Wayne to rule out a condition called immune-mediated polyarthritis, which can
08:08sometimes present with muscle loss.
08:10There we go.
08:13Now we wait.
08:15Bruce will be closely monitored while Dr. Loren waits for his test results.
08:34Owner Casey also has a gut feeling something is very wrong with her Cavalier poodle cross, Hazel.
08:42Are we ready? Are we going to go inside?
08:44Good girl.
08:46I've probably been to the vet about 15 times.
08:49Now five years old, Hazel was just eight weeks when Casey adopted her.
08:54I saw Hazel and I was like, that's it.
08:56I love her already.
08:58Hi, Hazel.
08:59Hello, my love.
09:00Alright, we'll go this way.
09:01We'll go this way.
09:01She caught my eye right away.
09:03I think it was the eyebrows mostly.
09:05We'll just pop in here.
09:07Okay.
09:08How are you coming?
09:08Yeah.
09:09She's very, very smart.
09:10Very sweet.
09:11Very funny.
09:13Pretty girl dance?
09:14Yes.
09:15She is well trained, contrary to sometimes when she's very excited.
09:20But she's very, like, she's just a happy dog.
09:22Carol.
09:26Hi, I'm Dr. Edelman.
09:29Hi.
09:29Nice to meet you.
09:30Hi, sweetie.
09:31Hi, Hazel.
09:32I love her name tag.
09:33Oh my God, that's so cute.
09:34Okay, so, you've been through the ringer, I would say.
09:37Yeah.
09:38It took me a couple hours to go through all her records last night.
09:41She has been a little bit of a sick girl lately.
09:44Yeah.
09:44Quite suddenly, too.
09:46Recently, Casey started observing some alarming symptoms in Hazel.
09:51It was terrifying.
09:52I saw her starting to deteriorate almost, and she just wasn't herself.
09:56She was so lethargic.
09:58The look in her face, I could tell it was like, it's time.
10:01Like, help me figure it out.
10:02I took her to the vet right away.
10:04She was a little bit, like, not as worried as I was.
10:08I knew it was a big deal because she was acting very differently.
10:11I knew that it was something more serious.
10:14And then when the blood work came back, they were like,
10:16oh, she's really very life-threateningly anemic.
10:21Casey saved Hazel's life by knowing her dog
10:24and understanding when something was clearly wrong.
10:27Taking her to emergency was absolutely the right thing to do.
10:29In that moment, she needed a transfusion.
10:31Yeah.
10:32I know, this is emotional.
10:34No, that's okay.
10:35That's okay.
10:35Here.
10:35This is why we have Kleenex in all of our rooms.
10:38Without an emergency blood transfusion,
10:41Hazel would have died.
10:42Unfortunately, a red blood cell transfusion
10:45is really just a temporary band-aid.
10:48Vets were unable to diagnose the cause
10:50of Hazel's strange and sudden loss of blood cells.
10:54I'm gonna look at her.
10:57Hi, baby girl.
10:59She's a little bit pale.
11:02Now there are clues that Hazel's anemia has returned.
11:06I don't want to wait too long.
11:07I don't think we have the luxury of time on our hands.
11:10I think she needs to be admitted to the hospital.
11:12And I think we should probably do it today.
11:15Does that sound...
11:16I know.
11:16I'm sorry.
11:17Oh.
11:18We'll take good care of her.
11:21Without a diagnosis and treatment,
11:24Hazel's anemia could kill her in a matter of days.
11:27We need to figure out what we're dealing with and fast
11:30before Hazel dips into that danger zone again.
11:33All right.
11:34Let's go, my love.
11:35Come on.
11:39She's special.
11:41She saved my life more times than I can count.
11:45So she deserves it.
11:46She's very important.
11:52She's a good girl.
11:53Dr. Lauren immediately orders a blood test on Hazel.
11:57If I'm lost, my mom will stop at nothing
12:00and will hunt down anyone
12:01who doesn't return me to her immediately.
12:04First, how anemic is Hazel?
12:06Then the bigger mystery, why?
12:09Oh, so brave.
12:11Good girl.
12:12Now we stick.
12:14After Hazel's recent transfusion,
12:16her red blood cell count rose to a healthy level.
12:19She's landing at 20%.
12:21That looks anemic.
12:24Now it's dropped dangerously low.
12:27If an anemia this severe goes untreated,
12:30she could die because her cells
12:33aren't getting enough oxygen to survive.
12:37Hazel's blood test also provides another clue.
12:44Anemia can happen a couple of very different ways.
12:47Either you're somehow losing red blood cells
12:49or you're not making them properly in the first place.
12:52That second category is much harder to solve
12:56and much harder to treat.
12:58She is unfortunately not regenerating.
13:02For some reason,
13:04Hazel's body isn't making the red blood cells
13:07she needs to survive.
13:10Not good.
13:21Canada West Emergency Line.
13:23Getting him assessed today is definitely the right step.
13:27Let's go this way.
13:30Oh, bless you.
13:32Bruce Wayne is rapidly losing muscle,
13:35a mysterious symptom
13:37typical of many life-threatening conditions.
13:40Dr. Lauren has done extensive testing
13:42to try and uncover the cause.
13:45Hello?
13:46Oh, hi, David.
13:47It's Dr. Edelman.
13:48Now she needs to update his owner, David.
13:52I got back all of the results from Bruce Wayne.
13:54The spleen looked fine.
13:55There was no obvious signs of cancer.
13:58All of the tests came back clean.
14:01In his chest x-rays,
14:03we're seeing generalized heart enlargement
14:05caused by just increased blood flow
14:07through a couple of his valves.
14:09It probably has nothing to do with his muscle loss.
14:12Okay.
14:13Heart disease due to Bruce's grain-free diet
14:17also isn't the answer.
14:19His diet was my top theory,
14:21so I'm a little bit baffled as to where to go from here.
14:24Yeah, this is crazy.
14:25You would have thought by now
14:27we'd find something that would tip us off.
14:29Yeah.
14:29I can tell David is just as frustrated as I am,
14:33and I really don't blame him.
14:34I'm going to have to dig a little bit deeper
14:37to figure out what avenues we haven't already gone down.
14:41Hey, perfect person I wanted to find.
14:43There's one other person Dr. Lauren can consult with
14:46about Bruce Wayne's case,
14:48neurologist Rachel Lampe.
14:50We did, like, chest rads, abdominal ultrasound,
14:53joint taps.
14:54Nothing came back abnormal.
14:56Dr. Rachel is one of our board-certified neurologists
14:59at Canada West.
15:00She really specializes in everything nervous system,
15:03which does include the muscles.
15:05We're kind of down to, like,
15:06this is the last possible option.
15:08Yeah.
15:08I think we need to consider neurological causes
15:11for Bruce Wayne.
15:12He is here now.
15:14Are you guys fully swamped today?
15:16We could definitely do EMG today.
15:17I can do it now if you want.
15:19My next appointment's at 1.
15:20I can grab him right now.
15:21Sounds good.
15:22Great.
15:22Every other test we've done so far
15:24really hasn't shown us anything.
15:27Oh, big nod.
15:31EMG stands for electromyography.
15:33It's a much more detailed way of setting the muscles
15:36and their activity.
15:40Bruce Wayne has been sedated so that his muscle movement
15:44doesn't impact the test results.
15:46So we just poke the needle into different muscles
15:49and look for abnormal activity.
15:51Using a small electrode needle,
15:53Dr. Rachel is measuring the electricity produced
15:56by Bruce Wayne's muscles.
15:59Okay.
16:01So all that noise is abnormal.
16:03But every muscle she tests is extremely stressed.
16:08So in a normal muscle,
16:10if a sedated dog, it should just be silent
16:12because the muscle's not doing anything.
16:15All that noise there almost sounds like a frying egg
16:18is what they say.
16:20Something is making Bruce Wayne's muscles
16:22twitch uncontrollably.
16:24This is a lot more abnormal than we thought it would be.
16:28We'll just go up to the front leg and see.
16:32It's pretty much anywhere you're putting that thing.
16:35It seems to be.
16:36Finally, a test has turned up something irregular,
16:39but they still don't know the cause.
16:43The EMG tells us something is abnormal with his muscles,
16:46but it doesn't tell us the underlying reason why.
16:49Something's going on.
16:56This way.
16:58Okay, sweetheart.
17:01All right.
17:03Turn you around.
17:04Probably need to take off your clothes.
17:07Whoa.
17:08Was that surprising to you?
17:10Down the hall, Hazel is being sedated for a procedure
17:14that may help uncover the cause of her anemia.
17:18You're okay.
17:19Oh, we're going down.
17:24Hello, we're ready for you and I am.
17:26If Dr. Lauren doesn't find a reason soon,
17:29Hazel's anemia could kill her.
17:32Okay.
17:33In cases like this, I put a lot of pressure on myself
17:36to really find the cause so that we can make a difference.
17:39Can you open up my bone marrow needle for me?
17:42Dr. Lauren will be using a needle
17:44to withdraw samples of Hazel's bone marrow fluid.
17:47Okay, that's ready to go.
17:49That's ready to go.
17:51Baby red blood cells are normally born in the bone marrow.
17:55Okay.
17:56The samples should show why Hazel isn't making those cells.
18:01My needle's hopefully down the very center of the bone.
18:03Let's see if we get anything.
18:07In the bone marrow, there's a variety of things that can happen
18:11that interfere with red blood cell production.
18:13Anything from cancer, infection, inflammation,
18:16or immune-mediated disorders.
18:21Just bubbles so far.
18:23Until we know the underlying reason,
18:25we don't know how to treat her.
18:28We're definitely in there.
18:30Come on, baby girl.
18:32Give me some marrow, please.
18:35Hazel's bone marrow is dry and brittle and doesn't contain much of the fluid that Dr. Lauren needs for her
18:41sample.
18:48Finally, some fluid starts to come out.
18:50It's like the worst bone marrow I've ever seen.
18:55But it's insufficient for a sample size.
18:58Come on.
18:59That's all you got.
19:00Come on.
19:00We need more than that.
19:02We may send that to the lab and they may say,
19:04there's not enough bone marrow for me to look at.
19:06Is that all you get?
19:07No, there's like nothing.
19:10I need more anticoagulant fast.
19:11Okay.
19:16Come on, baby girl.
19:18It's trying really hard.
19:20Come on.
19:21Ah!
19:22There we frickin' go.
19:25Let's go.
19:27Voila.
19:28It comes out.
19:29Thank God, mother of...
19:31It feels good when you get a good sample.
19:35This time, there's enough of the fluid needed for testing.
19:39That looks nice.
19:40We just have to hope that these samples point to a clear cause of Hazel's anemia.
19:45Hi.
19:45Oh, I'm sorry, my love.
19:48Because she really can't go on living like this.
19:51There we go, my dear.
19:56Does it carry?
19:58Yeah.
19:59He's 37 kilos.
20:00Are you brave, boy?
20:03It's okay.
20:05Meanwhile, Dr. Rachel and the neurological team need samples of their own.
20:10They have to figure out what's causing Bruce Wayne's muscles to waste away.
20:17I'll open the doors.
20:18Are you ready to come in?
20:19Yeah.
20:19The EMG basically showed us that Bruce Wayne's muscles are extremely abnormal.
20:25But we really don't know why.
20:27Okay, let's just get some samples.
20:29They're going to cut samples from Bruce Wayne's muscles to try to diagnose his abnormalities.
20:36We're going here.
20:37This whole caudal muscle is triceps.
20:40A muscle fiber analysis will look for clues pointing to inflammation, nerve damage, or a genetic disease.
20:48So, gastric's here, biceps is here.
20:51So, I'm cutting along with the muscle fiber.
20:53Yeah, so cut down the sides one centimeter apart and then cut across the top and then the bottom.
20:58And cut a little deeper than you think you should.
21:02There we go.
21:04Okay, did you go deep enough?
21:06Yeah.
21:08I'm going to need another surge of dopamine too when you get a sec.
21:10I'm sorry.
21:11Just minutes into the procedure, Bruce Wayne's heart rate spikes.
21:15He does not appreciate you guys doing this.
21:18Let me just give him a little bit of fentanyl.
21:21His painkillers need to be kept in a delicate balance.
21:26I just need to give that a minute.
21:29Too little could put stress on his heart.
21:32Too much and his blood pressure could drop dangerously low.
21:36I just need to be patient.
21:39There's always this fine balance between giving enough that you see the desired effect but not giving too much.
21:46Each stop down adds time.
21:49They can't afford to spare.
21:50How much time do we have left?
21:51We need the samples in 45 minutes.
21:54Okay, we've got to keep going.
21:55Muscle tissue begins to degrade as soon as it leaves the body.
22:00There, so it's all getting better.
22:03Bruce Wayne's heart rate begins to stabilize and the procedure can continue.
22:08And then you want me to cut across?
22:11Make it one by one, right?
22:12Yeah.
22:14Jamie, I have samples for you.
22:16Okay.
22:16The samples need to be sent to the lab within an hour of harvesting or their diagnostic value will be
22:23worthless.
22:25I'm down to another layer now.
22:27So I don't think the gastrox is not that superficial, right?
22:32He's really sensitive.
22:34Sorry, Bruce Wayne.
22:36The muscle is so reactive.
22:41But as they continue cutting, Bruce Wayne isn't reacting well.
22:46Hey, sorry.
22:47I'm just trying to see if someone can either get me a sentinel bolus or bring me the drug bin
22:50to the red line.
22:52Because he's painful.
22:53He's really reactive to what they're doing.
22:55Yeah, for a 37 kilo boy.
22:57While they wait on drugs, the clock keeps ticking down.
23:01Okay, we just need to keep going faster.
23:10And there it goes.
23:11I'm gonna run out of dopamine and blood pressure support.
23:14And it's your taco there.
23:16I feel frazzled right now.
23:19Me too.
23:20This is cutting it much closer than I'd like.
23:23The longer it takes to finish collecting their samples, the less viable they'll become.
23:30Ah, sick.
23:32Thank you so much.
23:33But if Shannon doesn't carefully manage Bruce Wayne's pain...
23:37Enter.
23:38Deliver.
23:39Okay.
23:40...they may not meet their deadline at all.
23:43There are definitely times where we need to completely abort the procedure if the patient is not responding the way
23:49we would like.
23:50I think patient care and patient well-being always comes first.
23:56Oh, yeah.
23:57That's the good stuff, eh?
23:59That's better.
24:00Okay.
24:01We gotta get the same.
24:03And this is the last sample you're taking, Rachel?
24:04Correct.
24:05Okay.
24:07Okay.
24:08We, like, are really out of time.
24:09Okay, okay.
24:10They've got the samples they need.
24:12Now we rush the samples to Theresa.
24:14This is your relay race, Jamie.
24:16Jamie, are you there?
24:17Yeah, I'm coming.
24:17Hold on.
24:19But they need to move fast to get them to the lab in good condition.
24:24Okay, we have it.
24:25Good job, team.
24:27Good job.
24:33The lab will screen Bruce Wayne's samples for abnormalities in hopes of finally finding an answer to the mystery of
24:40his muscle loss.
24:41Unless we find something abnormal, I don't necessarily have the opportunity to help him.
24:46And so we really want to find something so that we can make him better.
24:51You know who needs a sweet treat after this?
24:53Bruce.
24:58We're okay to recover in here?
24:59Yeah.
25:00Okay, lovely.
25:00We did pre-anesthetic blood work today.
25:06Hiya.
25:07Come here, baby girl.
25:09Wanna come out?
25:10In the ICU, Dr. Lauren has a new patient.
25:14Should we take this off for a sec while I look at you?
25:17Freedom.
25:18Yeah.
25:18Leah, a seven-year-old Jack Russell Cross, just came out of the ER this morning.
25:24Leah was referred to the emergency department because she was quite sick, with diarrhea, vomiting, really lethargic, she was pale
25:31and she was having trouble breathing.
25:33She's just the cutest.
25:36Leah's owners, Catherine and Daryl, rushed her to the hospital when her symptoms came on suddenly.
25:41Leah is from Mexico, Veracruz.
25:45We got her when she was nine months.
25:47She drew for about 20 days with 11 dogs.
25:52She is a rescue.
25:54After we got married, we felt like that was the time for starting a family and she was our first
26:01member of our family.
26:03Can I listen to your heart?
26:05The ER made several alarming discoveries.
26:09She had an ultrasound done that showed a bunch of her lymph nodes in her belly were really big.
26:16There was a mass in her chest, there was fluid in her chest.
26:19The emergency department removed about 150 mils of fluid and they did some blood work and they found she had
26:26very few platelets.
26:29With her platelet levels how they are, there is a risk that she could bleed.
26:34She's kind of a ticking time bomb.
26:36Platelets are crucial for blood clotting.
26:39Leah has so few, even a small internal bleed could kill her.
26:43I could stumble with her all day.
26:45She smells like my dog.
26:47She smells like jelly.
26:49Leah's enlarged lymph nodes and the mass in her chest make me think this could be lymphoma.
26:54I feel like we need to biopsy her at this point, but I'm very nervous.
26:59Inserting a biopsy needle into the mass in Leah's chest may cause her to bleed out.
27:04So Dr. Lauren needs to take precautions.
27:08We have one unit of negative in hospital that was ordered in yesterday.
27:12Okay, let me just call Danica.
27:13If Dr. Lauren goes ahead with Leah's biopsy, she'll need an emergency blood transfusion on standby.
27:21Hey, just want to give you an update on our inpatient situation.
27:24This is a really tough decision for me to make because on the one hand, I really do think we
27:30need to sample the mass to rule out cancer.
27:32She has somewhere between 20 and 80,000 platelets, so there is a risk of her bleeding.
27:37If I sample it and she bleeds, I'll be in a really tough spot.
27:42Not all bleeding stops.
27:44So I think we should cross match her to the negative unit if it hits the fan and we need
27:50to give her blood.
27:50Dr. Lauren has decided to go ahead with a high-risk biopsy.
27:55Okay, thanks.
27:58I hate this.
27:59It's very nerve-wracking.
28:01Because we have like one shot at this.
28:03My only hope is that she has enough platelets to prevent her from bleeding significantly and we get an answer.
28:12Knock on wood.
28:13Throw salt.
28:14In Jewish culture, we say, like we spit away the spirits, the bad spirits.
28:20Tui-tui.
28:34Leah is getting a biopsy today to determine if she has lymphoma.
28:39Hey, just letting you know, Leah just rolled into ultrasound.
28:42But it's a high-risk procedure for her.
28:45Leah really doesn't have many platelets to support blood clot formation.
28:50How many platelets do we have again?
28:52Somewhere between 20 and 80,000.
28:55Hoping for closer to 80,000.
28:58Okay.
28:59Leah's low platelets mean that even a small bleed could kill her.
29:05Because of the risks in Leah's case, we've already cross-matched her to blood and have it on standby in
29:10case we need it.
29:12Okay.
29:13So we're gonna go here.
29:17We're gonna be very gentle.
29:20Dr. Aaron is using the ultrasound to carefully guide her needle into the mass in Leah's chest.
29:26Okay, baby girl.
29:27No bleeding.
29:29We want to make sure that when we're poking a needle into the mass, we're not going through any blood
29:34vessels that could risk bleeding.
29:36We'll do the one for cytology first.
29:39Dr. Lauren needs samples for several different tests in order to be confident in her diagnosis.
29:47Nice.
29:48Is there any bleeding that you can see yet?
29:50No.
29:51Okay.
29:51But it's a balancing act with Leah's low platelets.
29:55Okay, let's do one more, I think, for flow.
29:57Okay.
29:59In Leah's case, we don't have the luxury of being greedy.
30:06I feel like I got stuff in there.
30:09I don't want to mess it up anymore because we need the cells to be alive.
30:12Okay, we're good.
30:14Is there any bleeding?
30:18If there are any signs of internal bleeding, Leah will need an emergency transfusion.
30:26It's good.
30:28Okay, great.
30:29Good job, Leah.
30:31Let's get these submitted right away.
30:34I am so relieved.
30:36Hey, this is cytology from an FNA.
30:39We just did it on a mediastinal mass.
30:41Now we just have to wait and see what we get back from these samples.
30:44And if it is cancer, I need to know that so that we can treat her appropriately.
30:50There.
30:50It's her little affirmation.
30:59It's pretty straight.
31:04Good job.
31:06Good man.
31:09Good job.
31:20Good man.
31:20And I'm really hoping she found something because every other test we've done has been inconclusive.
31:25Well, we found something abnormal.
31:27Type 2 fiber atrophy.
31:29Yeah.
31:29So she sees that most commonly with endocrine disease, which would be Cushing's or hypothyroidism.
31:34Based on his signs, Cushing's doesn't fit at all.
31:39Hypothyroidism or low thyroid?
31:41Yeah.
31:43Bruce Wayne's thyroid gland isn't making enough of the hormone that his muscles need to function.
31:48The weirdest way I've ever potentially diagnosed hypothyroidism.
31:52Yeah.
31:53Bruce Wayne's thyroid was tested and although it was within the normal range, it was at the low end.
31:58This was like right at the borderline.
32:00Right.
32:01Muscle atrophy is just not usually the primary complaint.
32:05But given these muscle biopsy results, maybe Bruce's thyroid has been the problem all along.
32:12I wonder if we're just catching it much earlier than the average dog.
32:15Because dad's so like astute.
32:17Definitely.
32:18Yeah.
32:19Thyroid disorders can typically be treated with a hormonal supplement.
32:23The hope is that starting thyroid supplementation will reverse his muscle atrophy.
32:29Well, thanks for your help.
32:31I mean, it was really helpful.
32:32That's the thing.
32:33Yeah, no, I mean, I'm happy it was abnormal.
32:34I was worried it might have been normal and then we wouldn't know what to do with him.
32:38If thyroid supplementation isn't effective, I'm going to be in a bit of a pickle because I don't know what
32:43comes next.
32:47There you go.
32:48He's back from surgery.
32:50We have different types of blood spikes.
32:52Do you feel better?
32:54Back in the ICU.
32:56Okay.
32:57I'm going to give you a top up.
32:59Hazel is finishing up a blood transfusion that should stabilize her enough to go home.
33:07Down the hall, her owner, Casey, is waiting nervously.
33:12Your house isn't really a home without your dog in it.
33:14It's hard to sleep without her.
33:18But first, Dr. Lauren needs to deliver the results of the bone marrow procedure.
33:24Good news is no cancer that we can see.
33:27Okay.
33:28Okay.
33:30We didn't even see like a glimmer of a cell that looked abnormal.
33:33Okay.
33:34Which is good.
33:35We're starting already.
33:37To diagnose the cause of anemia, you really need to knock down the possibilities one by one.
33:42No signs of infection.
33:44Okay.
33:44What we did see is that there really just weren't many red blood cell precursors at all.
33:50In Hazel's case, we know that it's not cancer or infection.
33:54And so what we're left with is just this one very rare form of immune disease.
34:00She has this condition called Pima, whereby the immune system attacks its own red blood cell precursors in the bone
34:07marrow, targeting them for destruction.
34:10To treat her, what we need to do is basically dampen that immune response.
34:15And we do that by suppressing her immune system with steroids and other immunosuppressants.
34:20I would say the majority of patients will respond within the first few months.
34:23I definitely have had some memorable cases that haven't.
34:29There's no guarantee.
34:30But my hope is that she will.
34:34And then at least I have a little bit more time with her, you know.
34:37Can I give you a hug?
34:38Yeah.
34:39You look like you need a hug.
34:41I really want to see Hazel make a full recovery, but we need to be patient while we wait for
34:46the medications to start working.
34:48Hi, baby bear.
34:49She looks like a million bucks.
34:51Hello.
34:52Are you feeling better?
34:54She says, I have blood and I feel good.
34:56She's going to be coming back for regular rechecks and blood tests to monitor her progress.
35:01We'll see you guys later.
35:03She's going to go home.
35:04Bye, Hazel.
35:05We just got to hope for the best.
35:07She's just the sweetest.
35:09She's just the sweetest.
35:10Yeah, let's go home.
35:22Good girl.
35:23Jack Russell Cross Leah has returned to Canada West.
35:27Hi, Leah.
35:28Yes.
35:29Nice to meet you.
35:30Nice to meet you too.
35:32Leah's biopsy results came back with a clear diagnosis and she's starting treatment today.
35:38No question.
35:39This is lymphoma.
35:41Come on, mama.
35:43Come on.
35:44So I've recommended chemotherapy for Leah.
35:47It gives her a chance.
35:49Come up.
35:50Good girl.
35:51The decision to start chemo for Leah's cancer hasn't been easy for owners Catherine and Daryl.
35:57It's really scary to think that she might have a disease that can, like, end her life.
36:05Why not give her a chance?
36:08She's my family.
36:09She really is.
36:15Hi, Miss Leah.
36:16Come on in.
36:17It's okay.
36:19I know.
36:19You're nervous.
36:20It's alright, sweetie.
36:21You're gonna do so good.
36:23The oncology team wears protective gear to administer chemotherapy, although the doses are lower than they are for humans.
36:32For chemotherapy in dogs, we never want to make them more sick with the treatment than the disease itself would
36:39make them.
36:40That's not fair to them.
36:44A lot of owners are quite surprised when they see how different it can be.
36:53Okay, going back, injecting.
36:57You're doing so good.
36:59If you go and see the dogs that are coming in and out of oncology for their chemotherapy...
37:05Good job!
37:07We're not dragging them in.
37:08We're maintaining their quality of life.
37:11Does she need a treat?
37:12Yes.
37:13Oncology is one of, like, the happiest places to be in the hospital, as weird as that sounds.
37:17Here's your comps.
37:18Yes.
37:19They get cookies when they're here.
37:21It's, like, a positive thing a lot of the time.
37:23They're walking out happy, wagging their tails.
37:27Oh, hey.
37:29They live months or years sometimes with really great quality of life.
37:41Okay.
37:42Right, Hazel?
37:43Yeah, I know.
37:44Let's go.
37:45This way.
37:46And then this way.
37:47Good job.
37:49Hazel has been on treatment for her anemia for two weeks.
37:52She's come in for a blood test to see if the medication is working.
37:56Good girl, Hazel.
38:01Hey.
38:02Hey.
38:03I just pulled blood on Hazel.
38:05Okay.
38:07Danica has sent the blood test results to Dr. Lauren for review.
38:11I mean, her anemia is definitely worse.
38:13She's down to 19.6%.
38:14So technically kind of could benefit from a transfusion.
38:18Yeah.
38:18But it looks like there's some reticulocytes.
38:22Reticulocytes are baby red blood cells born in the bone marrow.
38:26Hazel has three times as many as she did on her last blood test.
38:31Not many, but they are there.
38:33It could mean that this is an early sign of regeneration.
38:38Okay.
38:38Cool.
38:39Kind of a sketchy place to be, but I don't really want to transfuse her right now.
38:44Because if her bone marrow is starting to respond, then transfusing her could actually dampen her body's own response.
38:50Okay.
38:51We're seeing very early signs that Hazel's making her own red blood cells.
38:56But it's a very slow process and she's already anemic again.
39:01I could give her the blood transfusion she needs, but that might have the side effect of slowing down her
39:07own body's production of red blood cells.
39:10It's a tough call.
39:12This is one of those rare situations where even though her red blood cell count is low enough to warrant
39:18a transfusion, I'm going to hold off.
39:22All right.
39:22All right.
39:23Woo.
39:25It's definitely a bit of a scary decision to make, but could be in her best interest.
39:30This way.
39:31I know.
39:32So exciting.
39:32Okay.
39:33We're just going to need to keep a really, really close eye on things.
39:36This way?
39:37Yeah.
39:50Hey, come over here.
39:53Relax.
39:54All right?
39:55David has brought Bruce Wayne in for a recheck with Dr. Lauren.
40:00Hi, Bruce.
40:02Hi, buddy.
40:04Bruce Wayne has been on thyroid medication for the past two weeks.
40:09So, do you feel like he's putting back on any muscle?
40:12No.
40:13But, like, maybe two, three days after, his energy definitely came back.
40:18So he's a bit of a terrorist again.
40:20Good.
40:20I was actually quite happy when I saw literally every toy in the living room.
40:24So...
40:24Oh, my God. Amazing.
40:24I've been tracking his weight.
40:26He was 35 months.
40:28Wow.
40:28And now he's at 37.
40:29Oh, wow.
40:31He's doing great.
40:33So I'm really happy that Bruce is starting to improve.
40:37He still needs to gain back some of his muscle, but I'm happy that we're seeing movement in
40:42a positive direction.
40:43The fact that he's responding to the supplementation along with this new balanced diet is a good thing.
40:49Yeah, yeah.
40:50It's very possible that Bruce Wayne's owner saved his life.
40:54He believed something was wrong even when no one else did.
40:58Good job.
40:59Good job.
41:01Good job.
41:04I'm gonna go this way.
41:05Come here, my love.
41:08All right.
41:10For Hazel.
41:10For Hazel, yeah.
41:11All right.
41:12We can go this way.
41:13Hi, Hazel.
41:13It's been a week since Hazel's blood test showing that her anemia was getting worse.
41:20Hi.
41:21Hi, baby.
41:23Casey has brought her in so Dr. Lauren can see if anything has changed.
41:28So when I saw you last week, she had dropped, but on her blood work, there were very early markers
41:36of regeneration.
41:37And so we didn't want to give her another transfusion and dampen her own body's response.
41:42How has she been doing?
41:44She's been doing better, especially the last couple of days.
41:45She's been acting more like herself again and getting some more energy.
41:48She's even started being a little bit more of a menace again, which is nice.
41:52It's nice to see.
41:53I'm cautiously optimistic right now.
41:55I always say cautiously because you never know what's gonna happen.
41:58I'm really hoping that not giving Hazel another transfusion was the right call.
42:03Oh, yeah.
42:04I know.
42:04Let's go.
42:05Yeah.
42:07One, two, three.
42:09Ooh.
42:10If Hazel's red blood cell count has dropped again, it would be very disappointing.
42:14But we'll have to give her another transfusion.
42:17Good girl.
42:19Fun.
42:20Did it.
42:21The more often we give transfusions, the more likely it's gonna be that patients have negative reactions
42:26to them or start developing incompatibilities with their donors.
42:32Dr. Lauren wants to hear the number firsthand.
42:35Hey, Danica.
42:37What was it?
42:38It's 25, so stable.
42:40Oh, that's great.
42:41Seems like she's maybe responding.
42:44I am so happy that Hazel's red blood cells came up to 25%.
42:49If she continues on this track, this could mean her going into remission for her disease.
42:56So, she's at 25% today, which, like, I'm ecstatic about.
43:01Her body's started doing the work that it's supposed to be doing.
43:05I'm so relieved.
43:06It's working.
43:07We're gonna figure it out.
43:08Everything's gonna be okay.
43:09And to see light at the end of the tunnel where she could actually come off the medication
43:13and start to just be back to normal.
43:15Doing what she likes to do without her being tired.
43:17It feels good to know that she could be completely recovered.
43:21We're in a good place.
43:23Yeah.
43:23Right now I'm gonna cry.
43:25No, you're supposed to not cry.
43:27I know, I know, I know.
43:28This is the happy visit.
43:28Good tears, it's good tears.
43:29This is the happy visit.
43:30I know, I know.
43:32As horrible as the experience has been, it's been the best case scenario.
43:35Having her be her doctor.
43:38I take all the kisses I can get.
43:41She's helped save her and, like, that's all I can really ask for.
43:44High five.
43:45Yay!
43:47You're such a goof.
43:49Now that Hazel's on a good path, I'm really hopeful that things are gonna continue to trend upward.
43:54Good job, Hazel.
43:55You get to do your little victory walk.
43:58Her and Casey are gonna have a lot more happy time together.
44:02Ready?
44:03Are we ready?
44:04I'm ready.
44:04I'm ready.
44:05I'm ready.
44:06I'm ready.
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