- 2 weeks ago
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00:02Okay, let's go.
00:03Hi, Jeff, Jeff.
00:04She just was peeing everywhere.
00:05Ready?
00:06Lasering.
00:07Any small move the wrong way, it could be disastrous.
00:10I just got a little nervous.
00:11Something's, like, ruptured or something.
00:12Oh, there is something way more I've known.
00:15Meat skewers are not uncommon.
00:18It could be splintered.
00:19One more time.
00:20But have I gone too far?
00:22Okay, stop.
00:22And created a tear in her stomach.
00:25What's the matter?
00:26That's right.
00:27She was laying on the couch.
00:29Her eyes were just bulging out of her head.
00:32Dasha's back.
00:33It's okay, sweetheart.
00:34She's a bit of an ongoing medical mystery.
00:38We need to focus on the brain.
00:45For Rosie.
00:47Okay, we'll go this way.
00:49It's leaking in both areas, which is very unusual.
00:53I think we should roll down to Rad.
00:55Perfect.
00:55I'm very happy.
00:56I don't need to see him again.
00:57At Canada West Vet Hospital in Vancouver, BC.
01:01Hello, hello.
01:02Internal medicine specialist, Dr. Lauren Adelman, tackles the toughest medical mysteries.
01:08Hi, Milo.
01:09Everyone knows I love a good, juicy mystery.
01:13You're the best boy.
01:15But even after she cracks a case, many of her patients require lifelong treatment.
01:21Milo's 10 already.
01:23I didn't know that you'd make it to your 10th birthday when you went through everything you did.
01:27Five years ago.
01:28Hi, my love.
01:29Dr. Lauren saved Milo's life after diagnosing him with an extremely rare blood disorder.
01:36Let me look at his toes to see how his nails are doing.
01:39They look fine.
01:40Okay.
01:41Just because the medication he's on can cause his toenails to fall off.
01:44Right?
01:45Yeah.
01:45So Milo is a bit of an ongoing medical mystery.
01:49My best guess is that he actually has a condition called polycythemia vera.
01:54Good boy.
01:55Milo's body produces too much blood.
01:59Milo's case in particular, where it's affecting all of his blood cells, I have never seen that before.
02:04Okay.
02:04So you said his PCV today was?
02:0770.
02:0870%.
02:09There's no textbook on how to treat it.
02:10So I've kind of created this protocol for Milo.
02:13Okay, so we're going to take out 15 mils per kg of blood today.
02:18He comes in every eight weeks for something called phlebotomy, which is essentially removing his blood.
02:24I'll help you flip.
02:25We remove a certain volume of blood depending on how many red blood cells he has that day,
02:30and then we replace it with an equal volume of saline so that he doesn't become dehydrated.
02:39I always think of internal medicine like a funnel.
02:42You know, there's a lot of people waiting to come see us.
02:45And any patient that comes in to us, they kind of stay with us most of the time for the
02:49rest of their lives.
02:50It went okay?
02:51Yeah.
02:52It's very uncommon that even once I find out what's going on, that it's a quick fix and I get
02:57to say goodbye.
02:58Okay.
03:03So UA, UPC are in culture?
03:06Yeah.
03:13Dasha, no, no, no, no, no. Just calm down.
03:16Outside the hospital, an emergency patient is arriving.
03:21Oh!
03:21It's a client Lauren didn't think she'd see again.
03:25Two-year-old French bulldog Dasha and her owner, Scott.
03:29She was laying on the couch and I looked at her and her eyes were just bulging out of her
03:34head.
03:34Her pupils were really big and she wasn't blinking.
03:37I picked her up and she just collapsed.
03:40She couldn't hold her head up.
03:41Dasha.
03:43What's the matter?
03:44Dasha.
03:45Come on.
03:47She started spinning.
03:51It's really scary.
03:53Come on.
03:54Let's go.
03:55I drove as fast as I could.
03:56I was afraid she was going to stop breathing because she couldn't hold her neck up.
04:00On the drive over, Dasha finally came to.
04:03Come on.
04:05This isn't the first time Dasha has been to Canada West.
04:09Oh.
04:10Just a few months ago...
04:13How are you even alive? How are you pooping?
04:15Dasha was suffering from a life-threatening inability to poop.
04:19It's broke my heart to see her suffer.
04:22Oh, this colon looks terrible.
04:25Dr. Lauren discovered a rare infection in Dasha's colon.
04:30Dasha, you did so good!
04:33And against all odds...
04:36Dasha made a full recovery.
04:39Oh, yeah.
04:40But once again, Scott is desperate for a diagnosis.
04:45It's like a seizure.
04:47I think she needs some real help.
04:51Oh, I missed you, I missed you, I missed you.
04:54I didn't want to see you again, but I missed you.
04:57Dasha's back, which sucks.
04:59Oh, God.
05:00She was doing great after the last visit.
05:02And then just very suddenly, she started having these very weird episodes.
05:07Dasha seems to have recovered from her seizure earlier today.
05:11But this isn't the first time it's happened.
05:13So from what Scott has told me, Dasha's had a few of these episodes now,
05:17and Scott's local veterinarian didn't have the tools to figure it out.
05:21Okay, she's good to go.
05:23Dr. Lauren wants an emergency ultrasound done on Dasha.
05:28Ready? Do you want me to distract her?
05:30Sure.
05:32Seizures can turn deadly, so she needs to get to the bottom of this mystery fast.
05:37Dasha didn't even scream.
05:41Are you going to feel the drug soon?
05:42It really breaks my heart to see her back here, but it just motivates me to try and figure out
05:48what is causing these episodes.
05:51Aw.
05:53Good girl, Dasha.
06:00From Dasha's mystery, to a dog who is one second away from his stomach being punctured.
06:09Good boy.
06:11Five-year-old Louie swallowed an entire chicken kebab.
06:16Hey, don't eat anything else, Louie.
06:17Wooden skewer and all, and now it's stuck in his stomach.
06:21Some dogs will literally eat anything in sight.
06:25Okay, no, no, no.
06:26Louie's trying to eat the endotracheal tube off the table.
06:29It's not his fault.
06:30They look delicious.
06:31There you go.
06:32Like, that's not even food.
06:34Whoa.
06:36Meat skewers are unfortunately not uncommon.
06:39The meat is harmless, but the skewers are a different story.
06:44Okay, so I'm going in.
06:47Let's see.
06:49The skewer could cause a life-threatening puncture to his stomach or enter his small intestine and become a surgical
06:56emergency.
06:57Show me the skewer.
07:00Using an endoscopic camera.
07:03Searching for stick.
07:05Dr. Lauren needs to track down and remove the sharp piece of wood.
07:10It doesn't help that there's, like, a ton of food everywhere.
07:13Like, there's kibble.
07:16Not only are you trying to find and remove this thing, which may be difficult to do in the best
07:20of circumstances.
07:21What's food? What's chicken? What's skewer?
07:25But you're trying to do it amidst, like, a sea of food swimming around you.
07:30That looks like chicken to me.
07:33Yeah.
07:34And it's really, like, fatty, so it's going to be kind of slippery.
07:38I don't see the stick yet.
07:40No.
07:41Piece of grass in here or something.
07:43Actually, you know what? If it was like a pre-made skewer, it's probably like a piece of onion.
07:47I haven't seen the actual skewer yet. Like, I've just seen chicken.
07:51And because the meat is on it, it's hard to see the actual skewer.
07:57The longer that the skewer is in Louie's stomach, the more likely it is to do damage.
08:02Either by puncturing through the stomach wall or even migrating into his small intestine.
08:08I just really don't want to have to send this dog to surgery.
08:11If Louie has to get transferred to abdominal surgery, it will mean several weeks' recovery and a greater chance of
08:18complications and infection.
08:21Oh, is that the stick?
08:23It might be.
08:26It kind of looks wrong.
08:27It kind of looks like it could be a stick, right?
08:29Yeah.
08:30I think that looks like the stick.
08:32Yeah.
08:32We can see it right there.
08:36Go, go, go, go.
08:38Annabelle threads the endoscope with a snare tool, which has a loop for catching objects.
08:44Okay. Close, close, close.
08:45Okay.
08:47Come on, skewer.
08:54What happened? Where did it go?
08:56I lost it.
08:58As soon as it hits the esophagus, the skewer gets stuck.
09:02Things go down easier than come up because that lower esophageal sphincter is better at letting things go one way
09:08than another.
09:09Hold on. Take this, take this, take this.
09:11They're really not meant to bring things back up.
09:16Dr. Lauren grabs a pair of long forceps.
09:20I can see it. Like, I can see the end of it.
09:25If I can just grab it, it's just right there.
09:29Come on, buddy.
09:30Give it to us.
09:32I can't have it anymore.
09:33It's, like, stuck in his esophagus.
09:35The skewer is being pinched by the narrow part of Louie's esophagus.
09:40I can see it, like, right there. This is so annoying.
09:44Unfortunately, the stakes are infinitely higher, and so no matter how frustrating things get, I really need to keep my
09:50cool.
09:51I'm just gonna do this gradually.
09:53Dr. Lauren goes back in with her scope to try for a better visual.
09:58It's like you don't want to cause too much trauma, so you're trying to, like, get it up but without
10:02literally lacerating the esophagus.
10:05And pull back slowly.
10:08Almost, almost.
10:10Okay, right there.
10:12It's not a great grab, but let's try. Just slow and steady pressure.
10:19You feel like you have something still?
10:21Yes!
10:23We got it!
10:25Gross.
10:26Okay, let's hope that's a whole stick.
10:28Looks like it could be splintered.
10:30Skewers can be ten inches long.
10:32And that's, like, four inches, maybe?
10:35The other half of the skewer is still in Louie's stomach.
10:38As we just thought, we got it.
10:41Oy yi yi.
10:42Okay.
10:44Round two.
10:46Took ten years off my life trying to get that first piece out.
10:51Just, like, literally a mess in here.
10:54Chicken's making my camera all greasy.
10:57There's so much fat on my lens.
10:58Do I want to be in charge right now? No.
11:01Do I want an adult to come in and take over?
11:04Yeah, that'd be great.
11:05It's hard having everything on my shoulders.
11:09Everyone's counting on you to get the job done.
11:12Okay.
11:13In those moments, like, it's you, and you're the one making the decision,
11:17and there's no one else to fall back on.
11:22Trying to stay super chill, but I'm not.
11:25Come on.
11:27I just really don't want to have to send this dog to surgery for half of a skewer.
11:31I'm getting so frustrated.
11:33The longer it takes for us to find the other half of the skewer,
11:37the more likely it becomes that we're going to have to send Louis to surgery.
11:41Oh, no, no, no, no, no.
11:45Uh, could anything go right?
11:48Oh, that's a stick.
11:49Is that a stick?
11:49That's a stick, yeah.
11:51Okay.
11:51Okay, we can't lose that a little bit.
11:53Okay.
11:56Okay.
11:56Oh, no.
11:58What happened?
11:58I'm ready to go.
11:59Just as Dr. Lauren sets her sights on the end of the skewer.
12:03Ah, we lost it.
12:05I'm ready to go.
12:07The camera clouds over with chicken grease, and it slips out of view.
12:13Okay, come back.
12:15Let's just have a moment and take a breath, because that was really frustrating.
12:20We saw it, and then it was gone.
12:23I just need to, like, regroup and think about this for a second.
12:29Oy, oy, oy.
12:29I know that if I'm getting super frustrated, that's only going to frustrate everyone else around me.
12:35Stress on top of stress.
12:37And if we're all fractured and not working well together, then there's no chance we're getting this thing out.
12:43So I'm just going to have to take a second and figure it out.
12:48I feel like there's a point in many foreign bodies where I'm like, I'm going to fail.
12:53Okay, Lauren.
12:56Let's think.
12:57I'm so frustrated.
13:02The soup walkie is banned from our house for a while.
13:06It's becoming more and more likely that Louie will need to be sent in for emergency surgery.
13:12This is a situation where I have no choice but to push through.
13:15Shake the stomach up a little bit.
13:17See if we can get anything moving a different way.
13:20It feels impossible, but I've been in situations where it's felt impossible before, and I've done it.
13:26It's going to happen.
13:27I'm going to go back in one more time.
13:28So I just have to have faith in myself.
13:32Dr. Lauren goes in with her endoscope one last time.
13:36Is that the stick there?
13:38And spots something that doesn't look like chicken.
13:41Keeps the onion maybe?
13:43I don't know.
13:43It might be the stick.
13:45It looks like it could be the stick.
13:45Yeah, I think it is.
13:48That is it.
13:49Yeah, that's definitely it.
13:50That's definitely it.
13:51She finally spots the skewer.
13:53Yeah.
13:54Try grabbing.
13:55Pull back.
13:57Annabelle gets the snare around one end.
14:01Okay, and then I'm going to wiggle you up.
14:03Okay.
14:04And Dr. Lauren begins to pull the skewer up.
14:08This is going to be the heavy cut.
14:10Come on.
14:11Okay.
14:12Oh.
14:13There we freaking go.
14:15No.
14:15They maneuver one end of the stick into the esophagus.
14:19You're coming with me.
14:21If we had the skewer, this would be like.
14:24Oh.
14:26We literally did.
14:27Yes.
14:29Okay, let's see.
14:30So yeah, like if you put these two together, like there.
14:33There's one pointy end, one smooth end.
14:35It is absolutely the entire skewer.
14:39We freaking did it.
14:41Thank God.
14:41All right, Louie.
14:43Time to wake up.
14:46Oh, hello.
14:47There we go.
14:47There we go.
14:48Okay, give me two.
14:49Hi.
14:50Hello.
14:51This is a really happy ending for Louie.
14:54Shall we rule you back to ER, sir?
14:56He gets to go home.
14:58He doesn't have to have surgery.
15:01I hope this has been a learning experience for Louie.
15:04No more eating stupid things, okay?
15:06Yeah.
15:08Although I don't think it properly has,
15:10and I'm sure if he saw a skewer on the table,
15:11he'd go and do the exact same thing again.
15:14Yeah, that felt good.
15:16That was so much fun.
15:29While owner Scott waits nervously.
15:32So it's a recheck?
15:33It's a recheck.
15:34But with new issues.
15:35Oh, okay.
15:36Dr. Lauren turns her attention
15:38to her other emergency case, Dasha,
15:41hoping an ultrasound will give clues
15:43to the cause of Dasha's seizures.
15:46All right, let's use the other probe.
15:47I mean, a dog can't live like this the rest of her life.
15:50It's gonna get worse.
15:51It has gotten worse.
15:53She went to Fairfield over the weekend,
15:55which we just got records from,
15:57for like an episode of Collapse.
15:58Two days ago, Dasha went to her local ER for an especially severe episode.
16:04Her blood pressure was low.
16:06They were like, basically said she was half dead.
16:08The seizure caused Dasha's blood pressure to drop to a near fatal level.
16:14All right, let's have a look.
16:15Right now, we don't really know what these episodes are.
16:18They seem neurologic, but it's unclear.
16:21We just want to make sure there's nothing we're missing in the belly.
16:23Okay.
16:24Last time Dasha was here, I treated her for a multi-drug resistant E. coli infection in her colonic wall.
16:31She's been a saga for me.
16:36Dasha's seizures could either be related to her previous disease,
16:40possibly from the colon infection spreading to her brain,
16:43or they could be an entirely new problem.
16:46If there are signs in her colon that the infection has returned,
16:50that could be a clue that the seizures are somehow related.
16:56The colonic wall changes.
16:58They are definitely improved and then everything else is the same and normal.
17:03Okay.
17:04Dasha's colon is free of infection and appears unrelated to her seizures.
17:09So it's becoming more and more clear that what Dasha's dealing with
17:13is something truly neurological.
17:15So I think we need to focus on the brain.
17:17We hate O'Kings, Dasha.
17:30Okay, Jeff.
17:31Come on.
17:31Off.
17:32A new patient has arrived at Canada West.
17:35Okay, Jeff.
17:36Come on.
17:37Coming in to see Dr. Edelman.
17:39Yes.
17:40That's it.
17:41Good girl.
17:42Java's dedicated owner, Braylon, has been to countless vets since adopting her.
17:47We just celebrated our two-year anniversary with Java.
17:50I got her at 11 weeks.
17:52For Java.
17:54We'll just go this way.
17:56I remember the moment they gave me her.
17:58She just like sunk into me and it was meant to be.
18:03She was mine from that moment.
18:05I knew it.
18:06Yeah.
18:06I love you too.
18:11Hello.
18:12I'm Dr. Edelman.
18:14Hi.
18:14Nice to meet you.
18:15Nice to meet you.
18:16And you must be Java.
18:18This is Java.
18:19Hi, Java.
18:20You guys want to chat with you for a bit?
18:21Yeah, of course.
18:22Up, up, Jeff.
18:23Aw, sweet girl.
18:25You've been to several veterinarians.
18:28Unfortunately.
18:29It took me a good couple hours to read through all of Java's records.
18:32But I kind of just want to hear, in your own words, what's been going on?
18:37So, as a puppy, she had kind of like chronic UTIs.
18:41She just was peeing everywhere.
18:43For the past two years, Java has been having accidents on a daily basis and must wear a diaper if
18:50left unattended.
18:52Has she had any recent symptoms that are more like a UTI?
18:56Yeah.
18:57Chronic UTIs can also kind of crawl up into the kidneys and cause kidney infections, which could be life-threatening.
19:04And we think that in Java's case, she's actually had those too.
19:08We've kind of had to have her stop sleeping in our bed because I'll wake up and I'm covered in
19:12her pee.
19:12Aw.
19:13Yeah.
19:15Incontinence medication prescribed by another vet hasn't been effective.
19:19I also worry the meds that we're on, there's the potential of the estrogen toxicity poisoning.
19:24Something to consider as well.
19:25Totally.
19:25Something that she doesn't need.
19:27I don't...
19:27Exactly.
19:28I certainly don't want to have to deal with that heartbreak down the road.
19:31Yeah.
19:31The drug that Java's currently on, long term, can be a risk factor for bone marrow toxicity.
19:39Java's meds could have toxic, lethal side effects.
19:42She needs a better solution, because for Braylon, Java is more than just a pet.
19:48She's not only like a companion, but she comes to work with me every day.
19:53And she's an emotional support dog for seniors with mental health, low income, and physical disability.
19:58Do you have Java?
19:59Pop.
20:00Yes.
20:01Other.
20:02I actually originally got Java because I have kind of my own set of mental health and physical
20:08issues going on, and she is my grounding.
20:11She is my safety.
20:14I have a chronic illness, so she has learned to pull me my sweats when I need them.
20:19She will pat me when my heart rate's really high.
20:22Touch.
20:23She just is so important.
20:24She's so special.
20:25She's Java.
20:28So, is she only leaking when she's sleeping or resting, or do you find dribbles when she's
20:33awake too?
20:34Dribbles.
20:35Even eating breakfast some days.
20:37And she's not aware of it.
20:38No.
20:38She's like, whoa, what have I done, sort of thing.
20:41The hope is that we can find out what's going on, so she can get back to doing all
20:46those things, like sleeping in the bed with you.
20:48Yeah.
20:50Yeah.
20:51Like she's wet back here.
20:53Yeah.
20:54The other thing back here is that her vulva's quite hooded.
20:57Yeah.
20:57I know.
20:58I'm sorry I'm commenting on your body.
21:00Java's vulva is hidden by folds of skin, which can trap moisture.
21:05That can cause UTIs, but it wouldn't cause the dribbling.
21:08Yeah.
21:08This isn't the cause of Java's problems, but it might be a clue.
21:13Congenital urinary abnormalities tend to be genetic, and so often where you find one
21:19abnormality, you find others, especially in a dog as young as Java.
21:24Okay, let's go.
21:25All right.
21:26Bye.
21:27To solve the mystery of her incontinence, Java needs to be admitted for testing.
21:32Come on, Jav.
21:33Let's go this way.
21:34Oh, this way.
21:35Good job.
21:36I want to start with an ultrasound of Java's urinary system.
21:39It's not going to hurt.
21:40I promise.
21:41So good.
21:42The sleepings are coming.
21:45Hopefully, we can find something we can fix.
21:50Yeah.
21:50She's just peeing like a racehorse back here.
21:54Java's only been unconscious for a few minutes, and she's already lost control of her bladder.
22:06Incontinence and kidney infections in dogs can be caused either by things that are structural
22:10or functional.
22:12Functional problems happen when the muscles or nerves don't work properly to keep pee in
22:17the bladder.
22:19Structural things like a birth defect should show up on ultrasound.
22:23I suspect that there's something abnormal with her urinary system, which is like a game
22:28of telephone from the kidneys to the bladder to the urethra.
22:32All right.
22:34So this is a two-year-old lab female unspaid.
22:38Once again, Dr. Lauren needs Dr. Augustin's help.
22:42Dr. Lauren is definitely keeping me busy for all those imaging requirements.
22:48Do you want the lights off?
22:49Yes, please.
22:51Dr. Augustin scans Java's urinary system, hunting for abnormalities.
22:56Maybe we will find something.
22:58Hopefully.
22:59I want to see something structural, because that's something I might actually be able
23:02to intervene and do something about.
23:04The wall of the left renal pelvis seems to be a bit thickened compared to the right one.
23:08From the inflammation.
23:09Yeah.
23:10The first thing they see is chronic kidney damage, caused by Java's frequent infections.
23:15But that's not what's causing her symptoms.
23:18You can see the ureter here.
23:20So they move on to her ureters, two tubes that allow urine to flow out of her kidneys
23:26into her bladder.
23:28Oh, look at that.
23:29Oh.
23:29You see?
23:31Very suspicious.
23:33Oh, there is something way more abnormal.
23:35One of those ureters doesn't look right.
23:39In here, it seems to turn over quite a long time.
23:43Weird.
23:44That is funny.
23:45Yes.
23:46The element of surprise is kind of what keeps me going as an internal medicine specialist.
23:51Yeah.
23:51It's interesting.
23:53Who doesn't want to be surprised or shocked?
23:56Especially if it's something that I think I can fix.
23:59And that's not Java's only abnormality.
24:03That right side's really going.
24:05One of the two tubes into the bladder is producing a strong flow of urine that appears
24:11as an eruption on the ultrasound.
24:14Yeah.
24:15There it was.
24:16Tiny.
24:17But the eruption from the left kidney is small and faint.
24:22That would make sense for her case.
24:24There's something very strange about Java's urinary system.
24:29There's clearly something that's abnormal, but I still need to find a way to treat it.
24:34This is bizarre.
24:42They'll be right out for you.
24:44Easy and green?
24:45Yeah.
24:46Do you want to get this up?
24:47Yeah.
24:51Java is ready.
24:52Is she leaking?
24:53A little bit.
24:54Yeah.
24:56Java's life-threatening condition can't wait.
24:58Now I'm ready for my camera.
25:01After uncovering abnormalities in her urinary system, Dr. Lauren needs to get a closer look.
25:08The ultrasound was weird and I don't really know what we're going to find in here.
25:12So I'm going in.
25:14There we go.
25:17Clues showed up on Java's ultrasound pointing to one or more congenital abnormalities in the
25:22area where urine enters the bladder from the kidneys.
25:26Sometimes these abnormalities are repairable, but other times they can't be fixed.
25:34I won't really know until I get in there and see how things shake out.
25:37It's a very tiny urethra.
25:40Right away, there are more abnormalities.
25:43When you're scoping the urinary system, you're in a small space to begin with, so it's hard to move around.
25:49Everything's very small for a dog of her size.
25:52In Java's case, it's just kind of hard, layered on hard.
25:57It's just really complicated.
25:59Ugh.
26:03Hello, we're ready for you.
26:07All right, we'll pop into this room here.
26:12Meanwhile, in neurology...
26:19Technicians Shannon and Jamie are prepping one of Dr. Lauren's other patients for an emergency MRI.
26:27They need to find the cause of Dasha's unusual seizures.
26:32Based on Dasha's ultrasound, we know that her colon's okay, but that doesn't rule out that there's not some other
26:38infection or inflammation happening in her brain that's causing these seizures.
26:46It could also be something structural in her brain or even cancer, so hopefully the MRI is going to give
26:53us some answers.
26:54Ready to go, my girl?
27:00I'm closing the door.
27:04The MRI will take upwards of two hours, creating thousands of images of Dasha's brain a paper-thin distance apart.
27:14When we're doing an MRI, a lot of the times if we see something, it's not good news.
27:19My heart rate's coming up, so hopefully she's starting to respond to something.
27:23A lot of those things that we'll actually see show up on an MRI often don't have great long-term
27:29prognoses.
27:31Let's just wait and see if something's ruled.
27:39Hello, bladder.
27:41Back in internal medicine.
27:43So I see like a little yellow stream, so I'm trying to figure out where the yellow stream is coming
27:47from.
27:48Dr. Lauren is searching for the two openings where urine enters Java's bladder.
27:54Oh, I found one.
27:55They look like little nipples, like inverted nipples.
27:59The opening that connects to Java's right kidney is easy to find.
28:03So there's the one opening.
28:05Where is the other one is the question.
28:07But the other one isn't where it's supposed to be.
28:11Oh, there.
28:13And I think now I can see the tunneling through the wall.
28:16It's tunneled too far down in the bladder and opens lower than it should.
28:22Abnormally located.
28:24And too far back.
28:27What I'm worried about is that it's kind of emptying right where the sphincter should be.
28:31So some of that urine might actually be leaking.
28:33Dr. Lauren may have found the problem.
28:37Normally you have your urinary bladder and then at the very bottom is a door that opens and closes to
28:43control when urine actually leaves the bladder.
28:47Java's opening is outside or lower than the sphincter.
28:50She's just constantly dribbling urine that then is leaking to the outside.
28:54What I think I can do in Java's case is actually use my laser to bring that opening further up
29:02back into the bladder where it should be.
29:07Sometimes you just need another pair of hands.
29:10Okay.
29:10Dr. Lauren might be able to fix Java's problem, but she needs help.
29:17Matt Pollan is the hospital's newest doctor of internal medicine.
29:21Do you mind if I just grab a stool or something?
29:24Oh, yeah.
29:25You're too tall.
29:25I'm so tall.
29:26Yeah, yeah, yeah.
29:28Thank you so much.
29:30If you hold that, it might be easier.
29:32I love how you're the same height as me.
29:36You're literally the same height as me sitting.
29:39Pushing there.
29:41Before they start lasering, they need to insert a protective instrument into Java's bladder.
29:48Push, push, push.
29:51Yay!
29:51We got it in.
29:52Great.
29:53So now you're going to pass the blue one over top.
29:58This is annoying and hard to do.
30:00Definitely not like a straightforward ectopic urator.
30:04A wire catheter is then inserted into the instrument.
30:08You really need the catheter there to protect the other tissues from the laser,
30:12because if you're just lasering tissue, you could potentially rupture the bladder.
30:17Their goal is to use a laser to expand the abnormally small opening
30:22without cutting through any other tissue.
30:26Now we get to do the fun stuff.
30:27Everyone's going to need to goggle up.
30:30You push it on my nose more, ow.
30:33Better?
30:33Yeah.
30:34Laser on.
30:37Just keep pushing.
30:40Everything is so minuscule, but any small move the wrong way,
30:44it could be disastrous for the entire procedure.
30:47Lasering on.
30:50Lasering.
30:53I'm actually making some progress here.
30:56That's good.
30:57Yeah, we're still making some progress here.
30:59We're getting the job done.
31:01The laser is extending the opening of the tube further up into Java's bladder.
31:07You see that little band of tissue right there?
31:09It feels like it should be big enough.
31:12It now opens high enough that the sphincter should be able to contain its flow of urine.
31:18Standby.
31:19Standby.
31:20But Dr. Lauren spots a new problem.
31:23You see this?
31:25Something doesn't look right in the area she was cutting.
31:30That's a bit weird.
31:32I'm a little worried about what that is.
31:35As I'm just doing my final look around, the tissue just doesn't look quite right.
31:40I want Augustine to take a look.
31:42I just want to make sure I didn't rupture the bladder.
31:45Worst case scenario, if her bladder is ruptured, she needs to go to surgery.
31:54Okay.
31:55Dr. Lauren needs urgent assistance from the radiology department.
31:59Hey.
32:00I have a patient under anesthesia right now that I just was doing ectopic ureter lasering on.
32:06If Java's bladder is ruptured, immediate intervention is critical.
32:11Have I gone too far and potentially created a tear in her urinary bladder?
32:17I just want to make sure I didn't rupture the bladder.
32:19Okay.
32:19I don't think I did, but I would love for Augustine to put...
32:23He's just doing a procedure on another urgent patient in ICU.
32:26Okay, let me go...
32:27Yeah, okay.
32:31We'll wait till he's done with that one.
32:33Dr. Augustine is the only radiologist in the hospital at the moment.
32:38Seems like Augustine's a very needed man today.
32:42I feel like a huge responsibility that's personal.
32:45But I have to try and keep that away in these moments because I just need to focus on the
32:49medicine.
32:51Okay, good.
32:55Augustine, Alyssa told me to come find you in here.
32:57What's up?
32:58So, you know Java, the ectopic ureter case?
33:01Yeah.
33:02So I was just lasering her.
33:03I just got a little nervous that something's ruptured or something.
33:07Cassie and Danica have already begun transferring Java into another ultrasound room.
33:13One, two, three.
33:16All right, let's have a look.
33:21I won't feel relaxed until he tells me everything's fine.
33:26I didn't, like, rupture any arteries or the bladder.
33:29No, I don't think so.
33:30Based on what I see here.
33:32I'm not super worried.
33:33It looks fine.
33:34Great. Okay, I feel better.
33:36Java's bladder is intact.
33:39Look at that.
33:40Did I get... what?
33:41But that's not the only news.
33:43Oh!
33:43Look at that.
33:44Wait, that's way better than it was, right?
33:46Oh, big time.
33:47Dr. Lauren successfully expanded the abnormal opening into Java's bladder.
33:53That's cool.
33:54So the jet looks way stronger than it did before.
33:57It's really, really jetting.
33:59And urine is now flowing into the bladder normally.
34:03You did a good job.
34:04I was, like, panicking there for a second.
34:05I think I've actually made a big difference here.
34:08I'm definitely relieved that it's over.
34:10I feel like I've sweat through all of my scrubs at this point.
34:14Um...
34:15Wake up?
34:15Yes, we can wake her up.
34:18Hi.
34:20Java will rest in hospital for a few hours before heading home.
34:24Two words.
34:25Two words.
34:26Hopefully with improved bladder control.
34:29Oh, Java.
34:40Hi, baby girl.
34:43Dr. Lauren is checking in on Dasha.
34:45Why are you so tired still?
34:47Who is still sleeping off the anesthesia from her MRI.
34:51Dasha.
34:53She's still very out of it.
34:55She's enjoying her post-anesthesia.
34:58Okay.
35:02Hi.
35:03Hi.
35:03How you doing?
35:04Good, how are you?
35:05Good.
35:06All right, we'll go this way.
35:07I'm okay.
35:08Meanwhile, Dasha's owner, Scott, has just arrived at the hospital,
35:12hours before he was scheduled to pick her up.
35:15I hope I'm not rushing.
35:16I just came down here out of the...
35:17I was just thinking about her.
35:18I know you didn't follow me, so...
35:20Oh, no, you're okay.
35:21I know Scott's here, but I don't actually have results for him yet.
35:24I still need to review the results from the MRI.
35:28Until then, Scott will have to wait to find out what's happening
35:31with his best friend.
35:33That little dog has had such a tough life, man.
35:35It's just incredible.
35:38Oh, my God.
35:46Where's Java?
35:48Hi, Bubba.
35:50Hi.
35:51Come here.
35:51It's only been four hours since Java's laser procedure.
35:55She's already up, walking around, looking like she's ready to go home.
35:59You don't even look like you had anything done.
36:02And that just really highlights the benefit of these minimally invasive procedures
36:06where, you know, they're often able to go home so quickly
36:09because the recovery is so much faster.
36:11Are you ready to go home?
36:13Okay, Missy.
36:14You can come with me.
36:16Oh, she's dragging me.
36:19There she is!
36:23Hi, sweetbees.
36:24Owner Braylin's been on pins and needles ever since learning that Dr. Lauren may have found a solution to Java's
36:31life-threatening condition.
36:33All day, I couldn't do anything.
36:35I couldn't think.
36:35I couldn't...
36:36I couldn't focus.
36:37Hi, sweetbees.
36:38How are you?
36:39You are so loopy.
36:41Yeah.
36:42She may be a little bit more leaky tonight, just because she had sedation and all that on board,
36:46so don't judge her by what she does tonight.
36:49Things looked promising on her ultrasound, but they won't know for a few weeks if the laser procedure had any
36:55effect on Java's incontinence.
36:58We don't really know if things have worked.
37:01Sometimes it's obvious right away, but sometimes things take time, so it's a bit of a toss-up at this
37:06point.
37:07Thank you so, so much.
37:08We'll see you soon.
37:09Have a good one.
37:13Come on.
37:18Okay, Dasha.
37:20Dr. Lauren is sitting down with neurologist Ruby Ng.
37:24Oh, look at her cute cerebellum.
37:26To go over Dasha's MRI results.
37:29The main thing is that we're looking for symmetry or asymmetry.
37:33Everything looks very symmetrical.
37:35There's nothing like no big mass.
37:37So everything actually looks very, very normal.
37:39There's no sign of cancer or inflammation in Dasha's brain.
37:44Great.
37:45So we still think it's neuro, but nothing structural.
37:48It could be seizure activity.
37:49If these are truly seizures, then it would be what we call idiopathic epilepsy, meaning seizure disorder without any known
37:57cause.
37:57Okay.
37:58What we're dealing with is probably idiopathic epilepsy, which is essentially what we know in people as epilepsy.
38:03I wouldn't say it's common, but it's not an uncommon diagnosis.
38:07So if this is epilepsy, would you trial her on an anti-epileptic like Keppra and see how she does?
38:13Yeah.
38:13But the only way to confirm the diagnosis is to see how she responds to treatment.
38:19Okay.
38:20Well, the adventure continues.
38:22Exactly.
38:27Oh, hi.
38:29Hey, Scott.
38:29I wasn't trying to rush you when I got here.
38:31I was just thinking about it.
38:33Scott has been waiting for an hour to hear the results of Dasha's MRI.
38:37This is the longest I've never been around her since I've had her all day today.
38:42I know.
38:42It's the longest I've never been around her.
38:44I know.
38:45The bond that I have with Dasha is nothing compared to the bond that Scott has with her.
38:49Did you find anything, no tumors or anything?
38:52No.
38:57The MRI was normal.
38:58No structural brain disease, no evidence of inflammation.
39:02And there's really no evidence of cancer, which is a relief.
39:05There was nothing.
39:10We think this is epilepsy.
39:12Okay.
39:13I'm going to send Dasha home with anti-epilepsy medication.
39:18Okay.
39:19Give me an update.
39:20I will, of course.
39:21Thanks a lot.
39:22Yeah.
39:22Thanks for everything.
39:23I don't think we're going to be able to say if the medication's working until she goes
39:27at least a few weeks without any seizure activity.
39:32There we go.
39:34Now it's a waiting game to see how Dasha responds to treatment.
39:38I think as veterinarians, most of us are type A.
39:41We don't like waiting.
39:42I think a lot of the time we always want to do.
39:44We want to do more.
39:45Sometimes you just need to wait and see what's going to happen.
39:47But that's hard.
39:49There we go, sweetheart.
40:02Ready, Freddy?
40:04It's been two weeks since Jabba's laser procedure, and Braylon has brought her back for a checkup
40:09on her incontinence issues.
40:14Hi.
40:15How are you?
40:16Oh, my gosh.
40:16You grew up so much.
40:18I miss you, love you.
40:19I'm going to just feel back here to see if we're dry.
40:23I'm going to get a little sneak peek about what the update is.
40:25It's so good.
40:27We have not had a pee episode since we left.
40:30Really?
40:30Yeah.
40:31I don't think to look at the couch if it's wet.
40:33I don't think when we leave people's houses if she's gone somewhere.
40:36It's just not something I think about anymore, which is pretty wild.
40:39Really?
40:40Yeah.
40:40Oh, my God.
40:42Oh, my God.
40:43Did we fix you?
40:44Did we fix you?
40:46Oh, yay.
40:47Oh, my God.
40:47That makes me so happy.
40:48Yeah.
40:49Yeah, it's really amazing.
40:51Java's doing awesome and hasn't had any episodes of leakage.
40:56Normally, I'm at our, like, emergency 24-hour clinic at least twice a month, if not more.
41:03We haven't had, like, a bladder infection.
41:04We haven't had a UTI.
41:06Basically, she's a normal dog.
41:07Yeah.
41:08She used to notice it was, like, uncomfortable or irritated.
41:11Right, like she would lick down the two.
41:13Yeah, she was checking it out.
41:14Yeah.
41:14Just making sure.
41:15Yeah.
41:15And now, like, it's like she doesn't have a vagina anymore.
41:18Like, she doesn't even recognize it.
41:20Yeah.
41:20That's good.
41:21You shouldn't notice your vagina.
41:22Right?
41:22It shouldn't be something that you were aware of.
41:24Yeah.
41:25It should be, like, an asymptomatic organ.
41:28Totally.
41:28It's a bonus.
41:31Honestly, I would say you're done with me.
41:36It's very uncommon as an internal medicine specialist that I get to say goodbye to my patients.
41:42You're a free bird.
41:43A lot of our issues just don't have fixes or solutions or remission.
41:48She's graduated.
41:49We never thought we'd see the date.
41:52It was really nice that I got to kind of say bye.
41:54You have your graduation cap.
41:56Say goodbye to you.
41:57You're welcome.
41:58You could go out into the real world and just live your life.
42:01Chapter closed.
42:03Off we go.
42:04Come on, Jeffs.
42:18Yeah.
42:22Hello?
42:23At Scott and Dasha's home in Kelowna, BC.
42:27Scott, how are ya?
42:28Hey.
42:29Dr. Lauren is paying a virtual visit.
42:32Dasha's right beside me.
42:34Aw.
42:35Hi, baby.
42:37I think we're getting somewhere.
42:39Matter of fact, I know we are.
42:41Feeling better with your medication?
42:43Dasha?
42:43It is helping.
42:45Dasha hasn't had any seizures since starting treatment three weeks ago.
42:50And her overall health has been improving.
42:53In the last week, she's been playing more.
42:55A lot more energy.
42:57Dasha!
42:59I'm very happy to hear that.
43:01I'm cautiously optimistic.
43:03Me too.
43:04This is the first time I've been optimistic.
43:08Dasha may need to be on anti-seizure medication for the rest of her life,
43:11but that's pretty normal for a dog with epilepsy.
43:14It's not something that you have to worry about being dangerous to her.
43:17Okay.
43:18It's a very safe medication.
43:19The hope is that she'll never have a seizure again.
43:22If Dasha and Scott ever do end up back at Canada West,
43:26my hope is that it's just to give me some kisses and hugs.
43:31See you later, doctor.
43:32Hi.
43:34Okay.
43:35Things are looking good.
43:37It's just, I mean, I can't believe it.
43:40You know, it's just amazing.
43:44I've dedicated my life to helping dogs and cats,
43:48because they aren't just dogs and cats.
43:50They're family members.
43:52Yeah.
43:55You'd think she was in a race to see how fast she could eat.
44:02A retirement or более than quite so.
44:02You know, that's so cool.
44:03After the day.
44:03They're the chances of two adopters.
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