- 2 weeks ago
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00:03Rosie came in through ER.
00:05Do we know what she ate?
00:07Underwear.
00:08Ugh.
00:08It's always shocking to me what dogs will swallow.
00:10Oh, my God.
00:13Mitzi's had about 20 UTIs.
00:15In four years.
00:16I'm afraid that the answer will be, like,
00:18okay, well, we have to put her down.
00:20The fact that these UTIs keep coming back,
00:22I'm already in her bladder.
00:23Something really abnormal is going on.
00:26Oh.
00:28Amos, clearly he's in a lot of pain.
00:30Fever, inappetence, lethargy.
00:32We need to figure out what's going on.
00:34It could be life-threatening.
00:48Coming in to see Dr. Edelman today?
00:50Yes.
00:51Perfect.
00:51Hi, honey.
00:52It's okay, buddy.
00:54Good boy.
00:54Do you want me to sit?
00:55Here, Mitzi.
00:56Sit.
00:57Good job.
00:58At Canada West Vet Hospital...
01:00Oh, my God, he's so cute.
01:01Dr. Lauren Edelman...
01:03Look up for me.
01:05...specializes in diagnosing
01:06the most baffling medical mysteries.
01:09You're doing so good, Mr. Man.
01:12This is Bodhi.
01:13He is a rescue from Mexico.
01:15Good boy.
01:16But with adopted pets who come from mysterious origins,
01:20her job can be even more challenging.
01:23So when we have an adopted pet,
01:25a lot of the time we don't know what their history is.
01:28So that in and of itself can be a bit of a mystery.
01:31All that black stuff is fluid.
01:32Shouldn't be there.
01:33It takes really special owners to adopt a pet
01:38who has medical issues and then take that responsibility on
01:42both financially and emotionally and then go, you know,
01:46all the way with them.
01:47Okay, baby, do you want to go back to bed?
01:49There you go.
01:51You hang out with your little owl.
01:55Okay, boo-boo, you ready?
01:58Yeah.
02:00You're okay.
02:01Ever since adopting her cat Mitzi four years ago,
02:05new client Dorothy has been searching for answers.
02:08I think I had applied for like 30 cats.
02:11I got one call and they woke me up and they said,
02:14oh, I'm calling about Mitzi.
02:16Oh, Pete.
02:18Yeah.
02:19I just fell in love with her the minute I met her.
02:22For Mitzi, hello.
02:24You can follow me this way.
02:26Okay.
02:27She was three when I adopted her
02:28and then we started to have some health problems.
02:33Hi.
02:34Hi, how are you?
02:34Good, how are you?
02:35I'm Dr. Edelman.
02:36Nice to meet you.
02:38Hi, Mitzi.
02:39I know it's a little nerve-wracking in here.
02:41I was reading Mitzi's record last night.
02:43Actually, I finished reading Mitzi's record at midnight
02:45because it's so long.
02:46It's so long, yes.
02:47UTI, incontinence, UTI.
02:49I was just like, oh my God, this poor cat.
02:50Yeah.
02:52Dorothy estimates she's been to the vet 40 times
02:55trying to get help for Mitzi.
02:56Ever since I got her,
02:58she's been having some incontinence.
03:00Okay.
03:01So that's part of a problem.
03:02Okay.
03:02I can also see that she's uncomfortable a lot
03:06and it breaks my heart.
03:11It's okay.
03:12I know you've been dealing with this for years,
03:13so it's like, yeah.
03:15And like for a long time,
03:17she was bleeding from her bladder as well.
03:19Yes.
03:20That was scary.
03:22The first things I noticed were spots of pee on her bed
03:28and it got progressively worse from there.
03:31Mitzi has had back-to-back bladder infections
03:34for the past four years.
03:36I just want to kind of get a handle on it.
03:38Yeah.
03:39Because they keep telling me
03:41that it's now more and more antibiotic resistant
03:44and I don't want to get to a place where...
03:46We can't treat it.
03:47The infections are painful
03:49and affecting Mitzi's quality of life.
03:52They could also kill her.
03:54She's had about like 20 UTIs.
03:57Yeah.
03:57In four years.
03:58With our veterinary patients,
04:00quality of life is the most important thing.
04:03A cat should never have this many UTIs.
04:06It's threatening her life from a quality of life aspect.
04:08The only thing the shelter told me when I got her
04:11was that she requires clumping litter.
04:14So my suspicion is that she's had...
04:17Urinary issues.
04:19Yeah.
04:20When I went to go register my name on her microchip,
04:23I noticed that she had three other people
04:26on her microchip,
04:28which sort of suggested to me
04:30that she's been given up many times.
04:33Also, I don't know if you read this in her file,
04:36but she had a BB bullet...
04:37I saw it, yeah.
04:38...washed in her head.
04:40It also makes me wonder whether someone shot her in the head
04:45because of these issues.
04:48It's a horrifying thought.
04:52When I read the record, I see two major problems.
04:55So the first major problem is the urinary incontinence.
04:59Yeah.
04:59And then the second major problem are the urinary tract infections,
05:02which are sometimes associated with like bleeding and discomfort.
05:06And there's been very few times where her urine has ever been checked
05:11that she didn't have a UTI.
05:13Yeah.
05:13Given how chronic these signs have been,
05:15like we don't know what happened before she was rescued.
05:19But my suspicion is that maybe she was just born like this.
05:23I think we need to get to the bottom of it
05:25and try and figure out what is going on.
05:27And then step B is what can we do to manage it better?
05:30Dr. Lauren wants Mitzi admitted to the hospital immediately
05:34to begin diagnostics.
05:37I'm afraid that the answer will be like,
05:40okay, well, we have to put her down.
05:43And I'm not up for that.
05:46Little girl.
05:48Are you just still hanging out under here?
05:50Mitzi, did you find your happy place?
05:53Hi, Bubba.
05:55She's the little light of my life.
06:00Anything I can do to make her life more comfortable or better,
06:05that's what I set out to do when I adopted a cat, you know,
06:09is to provide them a safe and happy home.
06:16Well, my initial thoughts are that that's a very complicated case.
06:19I'm honestly not sure how everything fits together.
06:22I just feel really bad.
06:23You know, she's obviously been dealing with this for years.
06:31Urinary incontinence in cats can have a few different causes.
06:34It can be a congenital issue,
06:37some sort of structural problem that they're born with.
06:40There could also be a functional issue with the muscles
06:43that hold urine in the bladder.
06:45Or there can even be a neurological problem.
06:49Mitzi's adoption records have some clues
06:51that this is something she was born with.
06:53So right now, that's at the top of my list.
06:57The first step in solving the mystery
06:59is an ultrasound for Mitzi.
07:02Six-year-old, domestic, short hair, abdomen,
07:04going to the next line.
07:05If Mitzi was born with an abnormality,
07:09it might show up on ultrasound.
07:11But for that, Dr. Lauren needs help.
07:15Augustin is our radiologist.
07:17He might be the busiest person in this entire hospital.
07:22I have enough to tell you that, like,
07:24the wall here is definitely was abnormal.
07:27Like, it's so focal and such a thin layer
07:29around the, you know, a bladder,
07:30that I wonder to which extent, like, chronic recurrent UTI.
07:35Yeah, she's had a UTI, like, her entire life, basically.
07:38There's some scarring of Mitzi's bladder
07:40from her frequent UTIs,
07:42but the rest of her urinary system looks normal.
07:45With no useful clues appearing on ultrasound,
07:49Dr. Lauren will need to keep searching.
07:51The hope is that when we do a diagnostic test
07:53that we get something out of it.
07:55So, yeah, it's a bit disappointing.
08:06Danica, I'm getting suited up.
08:08Before Dr. Lauren can do more tests on Mitzi,
08:11it's all hands on deck for an emergency exam
08:14on a sick puppy.
08:15So we don't actually know if this dog's infectious or not,
08:19but because he is multisystemic,
08:21we're treating him as infectious.
08:23A seven-month-old Doberman puppy, Amos,
08:26is in protective isolation.
08:28When an animal's in isolation,
08:30that involves using gowns, gloves, booty covers.
08:35We're generally trying to protect the other patients
08:37in the hospital as well as ourselves.
08:40This isn't the first time Amos
08:42has been rushed to emergency.
08:44We love him.
08:45We kind of walked into the shelter,
08:47and he was super underweight,
08:49and we were like, we need to take him home.
08:51Like, he's not staying here.
08:52Very scared puppy.
08:54We've only had him for four months.
08:56He hasn't been feeling so great
08:58for the majority of the time that we've had him,
09:01which is tough, yeah.
09:05After his adoption, Amos continued to suffer
09:09from a barrage of different infections,
09:11despite dozens of vet visits.
09:14Since these owners have gotten him,
09:15he's been sick.
09:16His lymph nodes are big.
09:18Several months of really bad diarrhea,
09:21infections, nasal discharge coming from nowhere.
09:24It's been a lot.
09:25Yeah.
09:28We want to make sure that his quality of life
09:30is as high as it possibly can be.
09:33Yeah, I hope he's gonna be able to walk.
09:37Now, Amos has suddenly developed a mysterious limp
09:41and is refusing to eat.
09:43He seems very sleepy right now,
09:46but we'll see what happens as soon as we open this door,
09:48I guess.
09:49Do we believe?
09:50Yes.
09:53Amos.
09:54Good morning.
09:55Hey.
09:56Maybe the sedation finally kicked in.
09:58Amos was given drugs to keep him calm.
10:01His right hock is really swollen,
10:03and his lymph node here is quite big,
10:06and it's really hot.
10:07He has multiple swollen lymph nodes.
10:10When he was more awake, when he came in,
10:13he was definitely more painful, like right now.
10:15Oh.
10:16Okay.
10:17Hi, good morning.
10:19No.
10:20That woke me up better than coffee.
10:22We're not here to hurt you, buddy, okay?
10:25Holy shiitake.
10:26Hi.
10:27Amos.
10:27No.
10:28No.
10:28He likes to be told no.
10:29Yeah.
10:30As a working breed, he responds better to commands
10:32rather than...
10:37Danica's better at that than me.
10:38Sorry, buddy.
10:39That was kind of my fault.
10:40I thought you were really sedated.
10:42I'm not going to touch that leg again, okay?
10:45I'm not really sure what's going on yet with Amos,
10:48but clearly he's in a lot of pain.
10:51Hi, buddy.
10:52I know.
10:53Hi.
10:54Maybe he does respond to baby talk.
10:57Heart and lungs sound good.
10:59Do you have any neck pain?
11:00Hi.
11:01Good boy.
11:03So, I don't feel anything there.
11:06I am concerned, especially a dog this young,
11:09that we don't know what's going on.
11:11Okay, you want to come back in your house?
11:13Look, here's your stuffies.
11:14Here, look.
11:15Good job, honey.
11:17My plan is to get really aggressive with our testing
11:20until we can find an answer of what's going on in Amos' case.
11:25Amos must stay in isolation
11:27until Dr. Loren can find the cause of his sudden illness.
11:31Honestly, it feels like a different house without him,
11:33so I'm really hoping that the doctor will be able
11:36to figure out the root cause of it.
11:39Time is of the essence.
11:41You know, we need to figure out what's going on.
11:43If you're not eating and not drinking,
11:44just that in and of itself could be life-threatening.
12:01The next day...
12:04Oh, good morning.
12:06Amos.
12:07Hi, bud.
12:08Danica is prepping Amos for an onslaught of tests.
12:12Because a lot of his signs are affecting
12:14multiple different body systems,
12:16things can snowball really, really fast,
12:19and suddenly we don't have any options.
12:22Good boy.
12:24I'm not going to touch the right cock
12:26until we do the x-ray.
12:29Okay, so here's the mystery.
12:32Amos has a high fever, no appetite,
12:35and a lame back leg.
12:37Maybe it's as simple as an injury
12:39or infection in that leg.
12:43Just put him in lateral and then we'll roll him.
12:46Danica and Cassie are performing an x-ray on Amos.
12:50All right.
12:52Hello, I just did those tarsus rats.
12:56Amos transferred to me this morning,
12:57only seven months old,
12:59Doberman Pinscher.
13:00He's never been a healthy puppy.
13:01Fever, inappetence, lethargy,
13:04started becoming lame on his right hind limb.
13:07Okay.
13:08Radiologist Dr. Aaron Keenahan is reviewing Amos's x-rays.
13:12I'm not seeing anything interesting at all, actually.
13:16The x-rays we did on Amos are pretty unremarkable,
13:20so for better or for worse,
13:21they're not really telling me what's going on.
13:23With the x-rays showing no broken bones,
13:25they continue their search for the cause of Amos's lame leg
13:29with an ultrasound.
13:31Weird case.
13:32Yeah.
13:32He's also been so unhealthy his whole life.
13:36Is that why he was surrendered, do you think?
13:39We have no idea.
13:40But God bless these people because...
13:42It's a lot.
13:43Yeah.
13:44Anyways, needless to say, I'm stressed.
13:47Okay, sorry, remind me.
13:48Any GI or anything?
13:49Currently, his poop is the only thing that's, like, normal.
13:53Great.
13:54Yeah.
13:57Seeing anything exciting?
14:03Well, right medial iliac lymph node.
14:06It's just bigger than the left.
14:09Dr. Lauren also noticed enlarged lymph nodes
14:12on her initial exam.
14:14The one on the right's bigger?
14:15Mm-hmm.
14:16Might as well poke it.
14:17Okay.
14:18Dr. Aaron uses a needle to collect a sample
14:21from the lymph node to test for cancer.
14:25Done.
14:27Patients that have lymphoma can also have a fever.
14:30And in his case, he has multiple lymph nodes
14:33that are enlarged.
14:35One, two, three.
14:36Diagnosing lymphoma in any dog is devastating,
14:39but particularly diagnosing lymphoma in puppies
14:42is just heartbreaking.
14:44No one ever wants to diagnose that.
14:53Open 24-7, Canada West is a lifeline
14:57when pets face emergencies.
15:00Let's go.
15:02At 4 a.m., Dr. Lauren is called in
15:05for an urgent case.
15:06Okay, who is this?
15:08Rosie.
15:10Rosie came in through ER.
15:13Yes.
15:14Rosie, a four-year-old doodle, swallowed a pair of adult underwear.
15:20Okay, let me look.
15:22X-rays were taken to confirm the location of the underwear.
15:26Yeah, it's still in her stomach.
15:27Sure is.
15:28It's gonna induce.
15:29Yeah.
15:30Night-night.
15:31If left untreated, it could lead to a ruptured intestine
15:35or eventually death.
15:38It's always shocking to me what dogs will swallow.
15:41Undergarments in general, I would say, are pretty common.
15:43Like, dogs eat the most ridiculous things.
15:47I had a dog eat a lightbulb once.
15:50How did that go down?
15:51Holy cow!
15:54What kind of underwear are we going for here?
15:56Women's underwear?
15:58Probably women's.
15:59It's always women's.
16:00It's a surprise.
16:01One of the underwears from the laundry dropped on the floor
16:05and she grabbed it and she got it in her throat
16:09and she was choking on it.
16:10We were kind of panicking.
16:12Okay, Rosie.
16:15Using an endoscopic camera, Dr. Lauren needs to find
16:19and remove the underwear from the dog's stomach
16:22before it tries to pass into the small intestine,
16:25risking a blockage or rupture.
16:28What is that?
16:33There's the underwear.
16:34Whoa.
16:35This is...
16:36They don't look like underwear anymore.
16:42What are we using, by the way?
16:43A pelican.
16:44Okay.
16:45The scope itself just acts as a vehicle to get in.
16:50We then have the little channel on the scope
16:53where we can insert tons of different instruments
16:55to help with foreign bodies.
16:58Close.
16:59Close.
17:00Got it.
17:01Let's see how tough this is.
17:03Pull back towards me.
17:07Ooh, she's...
17:08Very tight.
17:09Yeah.
17:10Oh, my God.
17:10Okay.
17:11Ooh.
17:13The hardest part to get across
17:14is the lower softening sphincter,
17:16which is, like, currently our issue.
17:18Keep pulling.
17:21Oh, we're gonna be able to extract this.
17:29Oh, I lost it.
17:31Damn it.
17:35I'm gonna go back in and see where the situation is.
17:39The pelican grasper has slipped and released the underwear.
17:43If it can't come out through the esophagus,
17:45the dog will need emergency surgery.
17:47Now, half of the underwear are in the stomach
17:50and half of the underwear are in the esophagus,
17:52so slightly worse of a situation than I was in before.
17:55What kind of underwear are these?
17:56Thick.
17:58The underwear are stuck in Rosie's throat,
18:01and Dr. Lauren is running out of options.
18:03I'm wondering if we can grab the other end
18:05and then try and, like, bring both ends through.
18:09That might be an option.
18:11Open.
18:13Close.
18:13Close.
18:14Hold on to the dog.
18:16I've got her.
18:16Okay, so now I got the other end coming out next to it.
18:21Okay, this end's coming easier.
18:24Okay, ready for this action?
18:32Whoa.
18:34Idiot.
18:35Wow.
18:36It is women's underwear.
18:38Yeah, those weren't passing.
18:42Aw, poor esophagus.
18:44I hate to tell you this, but can you make sure they're intact?
18:47Yep.
18:49It does look intact.
18:51Nice.
18:52With the underwear removed entirely,
18:54it's good news for Rosie.
18:56As soon as she's awake, she can go home.
18:59But if she had surgery to remove it,
19:01like, she'd be out for two weeks.
19:02Okay, buddy, no more underwear.
19:05She can go to the park later tonight if she wants to.
19:07She can eat another pair of underwear tonight if she wants to.
19:11Hi.
19:12I know.
19:13Are you so tired?
19:14How does your tum tum feel?
19:16Sleep face.
19:32Chocolate break.
19:33For the stress.
19:35The ultrasound wasn't that exciting, which is good and bad.
19:39Relentless infections are taking their toll on Mitzi's quality of life.
19:44Emotionally, sometimes cases affect me.
19:46I'm human.
19:47With Mitzi and Dorothy, I could just easily see what a bond the two of them shared.
19:53It just makes it more challenging.
19:55One of the things that her owner mentioned is that she can be clumsy at times.
20:01And that's like a little bit of a red flag for me.
20:04Nothing showed up on ultrasound, so that puts congenital issues down at the bottom of my list.
20:10One other possibility is that the issue is actually with the nerves and neurological systems that control the bladder.
20:18So, I want to check and see if any brain or nerve problems are what's causing Mitzi's mystery illness.
20:25This is Mitzi.
20:27Hello, Mitzi.
20:29Dr. Francesca Samarani is a veterinary neurologist.
20:33Hi.
20:33Okay, there she is.
20:34Hi, Mitzi.
20:35You want to come out?
20:36Come here, buddy.
20:37Dr. Francesca.
20:39There you go.
20:40Okay.
20:41If Mitzi's brain or nerves are to blame, a series of neurological tests should reveal the problem.
20:48Let me know how to help you.
20:50Let's get a desk holder.
20:53Good job.
20:56Essentially, the whole act of soaring and voiding urine is mediated by the neurologic systems.
21:02It's going to be nasty.
21:05Oh, my goodness.
21:07This is why I could never be a neurologist.
21:10You guys just torture them.
21:12Very mean, Francesca.
21:15She's assessing cranial nerves, reflexes, paw placement.
21:20Okay, let's play with your feet.
21:22To get a sense of what Mitzi's entire neurologic evaluation looking like.
21:29This is my favourite part of the neuro exam, because it looks like they're like dancing, like a little ballerina.
21:34A cat that has urinary incontinence secondary to a neurologic problem would likely have obvious neurologic deficits on their exam.
21:43Neurological deficits could show up as poor reflexes, localized paralysis, or abnormal movement.
21:51Can I just see her walking around?
21:53And that's it.
21:54Good job.
21:56You want to go home?
21:58Let's eat.
21:59Look, your bag is over here.
22:01Go back.
22:02There you go.
22:03Good job.
22:04Good girl.
22:06So?
22:06So, good news, my neuro exam is normal.
22:09Yeah.
22:10When we have neurological causes, usually they are not able to walk or they're weak.
22:15We have a paralyzed tail or something like that, and she can't move her tail, no problem, and all the
22:21rest is normal, which is good.
22:22So, which means that it's not causing her urinary incontinence.
22:25No.
22:26Okay, well, we can cross that off our list, at least.
22:28I was hoping maybe we would find something that would explain it, but not today.
22:34Unfortunately, we're kind of back to square one with Mitzi.
22:38Of the three things on my list, Dr. Francesca didn't see any sign of neurological problems.
22:44There was nothing abnormal structurally on Mitzi's ultrasound.
22:48And, unfortunately, there isn't a test that exists for functional issues.
22:52So, basically, I've hit a dead end.
22:58Nothing in this hospital is built for short people.
23:00I have to keep going.
23:02I'm hoping that we find something that we can treat, because I know how deeply Dorothy cares for Mitzi and
23:09how committed she is to her care.
23:11Okay, bye, Mitzi.
23:26Okay.
23:27Dr. Lauren's frustrating day continues, as she's back to square one on another case.
23:33Amos.
23:34Amos, the seven-month-old Doberman, is suffering from a fever and limp.
23:39And he's still not eating or drinking.
23:42We are going back to bed.
23:45He's mad.
23:47Despite his swollen lymph nodes, testing showed no evidence of lymphoma.
23:53The big thing I wanted to rule out was lymphoma, which they didn't see any evidence of.
23:57But Amos' symptoms are getting worse, and we're really no closer to figuring out what's wrong with him than when
24:03we started.
24:05Okay, let's see.
24:07To me, it feels different than this side, for sure.
24:11X-rays showed no sign of injury, and there's no obvious infection or abscess.
24:16It's kind of like swollen up here.
24:19But Dr. Lauren is zeroing in on his painful back right leg.
24:24I'm palpating the abnormal leg on Amos, and I'm definitely feeling something abnormal.
24:30There's swelling there for sure.
24:32Okay.
24:34So, I'm just thinking, but I'm not the expert in bones, ligaments, soft tissues.
24:42Would love a surgeon to feel this.
24:44Emma, can you just see, is there a surgeon in the office?
24:48So I really need a surgeon to come in and do a proper orthopedic exam to make sure we're not
24:53missing something here.
24:54So, fever, inappetence, lethargy.
24:58Okay.
25:00Dr. Johan Karati is a veterinary surgeon.
25:03Ultrasound wasn't very exciting.
25:05Blood work's not very exciting.
25:07But he was not weight-bearing on his right hind leg.
25:10When he came in, he's very, very sensitive to touching of his hawk.
25:14Oh, yeah.
25:16Oh.
25:17That just made a really gross noise.
25:20That's one thing I don't do well with, is like joint stuff.
25:25We can feel, clearly, a swelling here.
25:28What do you think could be causing that?
25:30That's difficult to say because that does not feel like a trauma.
25:33And do you feel like the joint's swollen?
25:35Yeah. Here, I think it's an effusion inside the articulation.
25:39The swelling seems to be within the joint itself.
25:44Do you worry about it being a septic joint?
25:46That's possible.
25:47Yeah.
25:47You can have this with an infection, especially if he's a lot of pain.
25:52In pain, he is.
25:53Yeah.
25:53If Amos had a septic joint, it could definitely explain the fever, some of the systemic signs.
25:59Septic joints are really painful, so it could also explain the pain in his leg.
26:03So I would believe that as a possible differential.
26:06A septic joint happens when bacteria from a wound reach the joint.
26:11Bye.
26:12Okay, thank you so much.
26:13To test her theory that there's an infection within his joint, Dr. Lauren needs to do a joint tap.
26:21I go in, and then I draw back.
26:26For Amos' sake, and for his owner's sake, I really hope we're onto something here.
26:33All we can really do is wait for test results and hope we found the answer.
26:47Hey Lauren, I have blood work for you.
26:49Beautiful.
26:50Oh, awesome.
26:51Let's see.
26:52Test results are back for Amos, the puppy with the limp and fever.
26:56And it could be the break Lauren needs.
27:00I'm really glad we did the joint taps on Amos, because I think we might finally have an answer.
27:05Hello?
27:06Hi, is this Linda?
27:07How are you?
27:08Uh, I'm worried.
27:10Oh, of course you're worried.
27:12He's my only child.
27:13So we did the joint tap, and I did just get back the culture on the sample.
27:20It did grow in E. coli.
27:22And that is interesting to me.
27:24There is evidence of infection inside Amos' joint.
27:28That's bizarre. How does that happen?
27:30So it is possible it could be what we call hematogenous or from somewhere else in the body.
27:35We may never really know where this infection came from in the first place,
27:39but he's had so many different infections in the past,
27:42it's possible that the infection started somewhere else and ended up in his joint
27:46and has just been lingering there.
27:48Now, here's the complicating factor.
27:51The E. coli is quite multidrug resistant.
27:55Enrofloxacin is the antibiotic that it's showing best susceptibility to.
27:59However, in some studies, albeit very few,
28:03they have been shown to potentially affect cartilage development,
28:06and that could lead to cartilage issues long term.
28:10I don't know that we have any other option in his case.
28:13Okay.
28:14The antibiotic could have dangerous side effects.
28:17But without it, Amos could die.
28:20If he doesn't respond to this antibiotic,
28:23then we're going to be in a pretty scary place in terms of our options.
28:26I want to do two weeks, and then I want to see him back at the two-week mark to
28:31reassess.
28:32Okay. That sounds good.
28:33Thank you so much for your time, your patience, explaining everything.
28:37You're welcome. Okay. Bye.
28:48Bye.
28:50It will be two weeks before they know if the antibiotic is working.
28:54No, dude. Here, you're on your cone off?
28:58In the meantime, Amos is well enough to go home with painkillers.
29:01No, this way. This way.
29:04Who's that?
29:08Oh, my God.
29:10I know, it's Mom.
29:11Diagnosing complex internal medicine issues requires a team effort.
29:16Hi, my baby.
29:18Working with dedicated owners who are willing to make sacrifices for their pets.
29:23He's like the car.
29:25He's like the car.
29:29He's crazy.
29:31Yeah.
29:48Come here, Mitz.
29:49Dr. Lauren desperately needs a break in another case.
29:53When she's drunk, we'll take the cone off.
29:55Every test she's done on Mitzi has come up clean.
29:59There has to be some reason that she keeps getting new infections.
30:03There has to be something structurally abnormal here.
30:08Dr. Lauren wants to get a better look at Mitzi's urinary system using her endoscopic camera.
30:14We're going to scope her because the ultrasound didn't really show much.
30:17It's a much more invasive procedure.
30:20But with Mitzi's quality of life declining, there's no other option.
30:24When we put a patient under for a urinary scope, basically what we're doing is we're giving them some sedation
30:30and then we're inducing them to anesthesia.
30:36She's leaking a little bit.
30:37That's alright.
30:38She's incontinent to start.
30:41Making sure they're under a good plane of anesthesia and then I can go in with my scope.
30:46Okay.
30:47As soon as she was anesthetized, she was just leaking pee.
30:51She was?
30:52Yeah.
30:53I do feel like her vulva is just like quite like tiny.
30:58It's cat.
31:00Unlike humans, female cats' urinary and reproductive systems exit the body through the same opening.
31:08Okay, let's see.
31:11Mitzi's is unusually small.
31:16Oh, I'm already in her bladder.
31:18Wait a second.
31:20What the hell?
31:22But that's not the only abnormality.
31:25I didn't even see like-
31:26That was too easy.
31:27That was-
31:28There is no-
31:29Does she have a, not have a vagina?
31:34I'm very confused right now.
31:37Okay, this is her, like that's immediately outside and then I'm going in and I'm like already in a tube
31:44and then-
31:55There's no vagina or vestibule.
31:56It's literally just going straight into the bladder.
31:59No wonder this cat's having like a million UTIs.
32:01And also no wonder she's incontinent.
32:03It doesn't even seem like she has a urethral sphincter.
32:05I've never seen anything like this.
32:09For urination and reproduction, female cats have just one external opening, branching into the urethra and vagina.
32:17Mitzi doesn't have that branch point that we call the vestibule and she doesn't have a vagina either.
32:23Her urethra is just coming from her bladder and exiting to the outside world.
32:28Let me just see the distance.
32:31So her urethra is like four centimeters and then I'm in her bladder.
32:35I've never, I've never seen that before to be honest.
32:39Mitzi, Mitzi no Bitsi.
32:41Mitzi no Bitsi, I like that.
32:43That's good.
32:45The question that I'm not wanting to ask myself is how can I help this girl?
32:51Treatment options might be limited or non-existent.
32:55Yoy, yoy, yoy, yoy, Mitzi.
32:58Sometimes even when we find something and get an answer, it doesn't necessarily mean that there's an easy solution.
33:04I was hoping to find something I could fix.
33:07That's the problem with medicine.
33:09Even when you find the answer, sometimes it's not the answer you want.
33:27I'm nervous to see what comes back.
33:29After Mitzi's revealing urinary scope, Dr. Lauren asked Dorothy to come into the hospital for an update.
33:37Not having answers as someone who likes to have answers, it's been a lot.
33:46Hello.
33:47Hi, how are you?
33:48Good, how are you?
33:49Good.
33:49So, she did great.
33:51Her scope was very interesting.
33:56Okay.
33:58Having to go in and tell an owner that her cat doesn't have a vagina was not something I really
34:04ever expected to have to do.
34:06Essentially, her vulva opens straight up into her urethra, which then goes to her bladder.
34:13Huh.
34:14Interesting.
34:15She doesn't have a vestibule or a vagina that I can see.
34:19None of this is there.
34:22Common? Uncommon?
34:24I've never seen this before.
34:25Like, very uncommon.
34:28Okay.
34:28And I did a literature search and there are a few case reports from like the 90s of like congenital
34:34incontinence in cats.
34:36We're talking about a handful of cats.
34:38The reason why I think this is probably something she was born with was because she obviously did have uterine
34:45horns at some point because they did a spay on her.
34:48I just don't know where it ever connected to externally.
34:53Now the question is, is there anything we can do about it?
34:57And that's my concern right now is that I don't know that there is.
35:01I need to talk to one of our surgeons and see, can we do anything like more surgically about it?
35:07If we can't, then what we're left with is trying to medically manage her as best as possible, which would
35:14likely mean, I think, starting her on PPA.
35:16This drug basically works by strengthening the sphincter that keeps the bladder closed.
35:24Basically, that helps to make this tighter.
35:28The thing is, I don't even know really if Mitzi's bladder has a sphincter to act on because her anatomy
35:34is so abnormal.
35:36So we're just going to try it and we'll see if it works.
35:41I feel bad whenever I can't be like, oh, this is exactly what we can do to fix her.
35:44This is an answer.
35:46Yeah.
35:46We have more information.
35:47Yeah.
35:47I'm so, I'm so grateful.
35:49Okay.
35:50Perfect.
35:50Well, we'll go get her.
35:52You're welcome.
35:54Floored.
35:55Absolutely floored.
35:57Hello, sweet girl.
35:59I heard you were good.
36:01Of course, I'm the one that has a cat that just never had a vestibular vagina.
36:07Like, of course.
36:08Of course it's me.
36:09Yeah.
36:10We can go home.
36:11I would never in a million years would have thought that she would have a congenital issue
36:15like that.
36:16Yeah.
36:17I'm surprised.
36:20I'm surprised.
36:36Come here, sweet boy.
36:37Come here.
36:38It's been two weeks since Amos started antibiotics for his joint infection.
36:42Hi, Amos.
36:44Say hello.
36:45He's returned to see Dr. Lauren so she can assess if the drugs are working.
36:50It's your favorite place, bud.
36:52Look, I hope they don't leave me here again.
36:55I know.
36:56You're all right.
36:57Unfortunately, Amos has cultured E. coli from one of his back leg joints.
37:01We're really running out of options for Amos if this antibiotic doesn't work.
37:07Don't worry, we're not leaving you here.
37:09Hi.
37:10Hello.
37:10How are you?
37:11Good, how are you?
37:11How are you?
37:12Look at you sitting on that chair.
37:14Hi, bud.
37:15Oh, I know.
37:16Hi.
37:17Well, at least you're excited to see me.
37:18He's not like this is the lady that tormented me last time.
37:21I did most of the stuff while he was sedated so he has no recollection of it, right?
37:26Hi, buddy.
37:27Looks like he's using that leg way better than the last time I saw him.
37:31Yeah, he's definitely weight-bearing.
37:33It doesn't seem like it's hurting.
37:35I'm really happy to see Amos in such good spirits and putting weight on that leg again.
37:40Hopefully, that's a sign that our treatment's working.
37:42Is he okay on the couch?
37:43Yeah, yeah, yeah.
37:44Is that okay?
37:44Sorry.
37:45We're at a bad hospital.
37:46This couch has already been replaced like three times.
37:49He's allowed on the couch at home.
37:50My dogs sleep under the covers.
37:51Okay.
37:52Okay.
37:53Oh, my.
37:55He's like, I like her now.
37:57I like her now.
37:57That's okay.
37:58I love it.
37:59I love it.
38:01Amos has really done a complete 180, and I love to see it.
38:05It's great that he's acting like a puppy again, and that's probably largely because he's no longer in pain.
38:11And obviously, he's got good energy levels.
38:13Looks like it to me, at least.
38:14Yes.
38:15Amos.
38:16Amos.
38:17It's a fake tree.
38:18Um...
38:19Leave the tree.
38:19Let's not get a foreign body here.
38:21I don't want to have to scope you.
38:23Come here, buddy.
38:24I'm just feeling his lymph nodes now.
38:27Definitely feels better.
38:28Good.
38:29Yeah.
38:30Well, thank you.
38:31You're welcome.
38:31It's great.
38:32I'll take the win.
38:33They may never know how Amos' joint became infected, but treating it in time likely saved his life.
38:40Amos was a really tough case.
38:42There's not a lot of people who would take home a dog that sick and would have the determination to
38:47keep going until we found an answer.
38:50All right, buddy.
38:51This way.
38:54Bye.
39:04The scope was probably the weirdest scope I've ever done.
39:09Dr. Lauren is discussing Mitzi's case with surgeon Dr. Will Hornsha.
39:15Essentially, she's missing her vagina and vestibule.
39:18Okay.
39:19So I'm pretty skeptical that there's anything that we're going to be able to do surgically to help Mitzi, but
39:24I want to discuss her case with one of our surgeons just to be sure.
39:29In Mitzi's case, we've solved the mystery.
39:31We know she's getting all these infections because her bladder is basically open to the outside world.
39:37But we don't know how to fix it.
39:39What I'm hoping is that there's a surgical way to rebuild something closer to normal anatomy and improve her quality
39:46of life.
39:47I'm assuming that there's no signs that this could be, like, intersex or, like, partially male or any, like, scar
39:54tissue that would suggest, like, surgery in that area.
39:57It doesn't seem like that.
39:58Okay.
39:58There's no evidence of, like, male counterparts.
40:02Yeah.
40:03Okay.
40:03All right.
40:03I mean, we have not yet been able to replicate, like, a cat sphincter.
40:07The only thing available is where you put something around the urethra and kind of inflate that gradually with saline.
40:14But I don't know that procedure having done previously successfully on cats.
40:18It would probably require, like, cracking her pelvis, right?
40:20Probably, yes.
40:22Sounds like surgery as an option for Mitzi isn't really a great one.
40:26It's just way too experimental and too high risk.
40:29We could potentially do more harm than good with these treatments.
40:32Yeah.
40:32All we can really do at this point is hope that the drugs I've prescribed will have some effect because
40:38otherwise there's not a lot we can do.
40:41Okay.
40:42Yeah.
40:43Helpful, but not super helpful.
40:53Oh, it's okay, boo-boo.
40:55I can actually undo this little thing.
40:58It's been three weeks since Mitzi started her trial on a new medication.
41:04It's not an escape hatch, but you can look.
41:07Yeah, I'm excited to see Mitzi.
41:09I'm excited to see how she's been doing.
41:12Excited, but also, like, nervous, because you never know, right?
41:15Sometimes you go in and they're like, yeah, they're doing horribly.
41:18With no possible surgical treatment, if this drug doesn't work, Mitzi is out of options.
41:26Hello, hello.
41:27Hi, how are you?
41:28Good, how are you?
41:29Good, thank you.
41:30Hi, Mitzi.
41:32So, how have things been going?
41:36Not bad.
41:37Okay.
41:38She's on the PPA now.
41:40Okay, yeah.
41:40The five milligrams.
41:42Okay.
41:42She seems back to, like, a stable state.
41:44Okay.
41:45Not showing any obvious, like, lower urinary signs right now.
41:48Not right now.
41:49Like, peeing regularly, peeing a good volume, no straining, no blood.
41:52No.
41:53Okay.
41:54So, pretty much, like...
41:55Stable.
41:56Like, the most stable she can get.
41:59Okay.
41:59Any leaking?
42:00Not that I can see.
42:01Okay.
42:01Whereas before, I could see it, like, actually coming out of her.
42:04Okay.
42:04Now, I'm not seeing that.
42:06Okay.
42:06So, my suspicion is if there is leaking, it's, like, when she's...
42:11Yeah.
42:11So, overall, it sounds like things are going reasonably well.
42:14Yeah.
42:15Okay.
42:16It's a relief to know why.
42:19Like, that really is 90% of the battle, I think.
42:24Mitzi will require monitoring for any signs of incontinence or infection.
42:29Likely for the rest of her life.
42:31A lot of the times I joke with owners, like, okay, see you for the rest of your pet's life.
42:35But it's true.
42:36Like, a lot of the times these are chronic issues.
42:39One of my assistants has a nickname for her now.
42:42She called her Mitzi Nobitzi.
42:47So, she has a new nickname from us.
42:49Right, Abby?
42:50Oh, that's funny.
42:52I not only am going to get to see Mitzi forever, but I'm also going to get to see Dorothy
42:56forever.
42:57And it's crazy how close you can become.
43:00You almost feel like family or friends to them.
43:03And I think that's one of the special things about internal medicine.
43:06All right.
43:07Yeah.
43:07Sounds great.
43:07Okay.
43:08Awesome.
43:08Thank you so much.
43:09You're very welcome.
43:16What's up, Boo Boo?
43:17I'm so grateful to have Dr. Edelman on my team.
43:21It definitely feels like I'm not alone that I have someone fighting with me for her.
43:28This is Mitzi's favorite box.
43:30She has a nice convertible soft top.
43:33Mitzi's ride.
43:34It brings peace to have an answer.
43:37It explains so much.
43:39All the pieces fell into place and explained why she was given up so many times before.
43:44And it just makes me so thankful that she's with us.
43:49Because if I hadn't adopted her when I did, she probably wouldn't be here today.
43:53This is where she hangs out while I'm working.
43:56And she sleeps, sleeps, sleeps.
43:59She is really, really extra special.
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