By John Andersen, DVM
After graduating from veterinary school at Virginia Tech, I had the challenging experience of completing an internship in small animal medicine and surgery at North Caroline State University’s Veterinary Teaching Hospital. This was probably one of the most stressful and overwhelming years of my life. We interns were definitely thrown into the fire, going straight from being a fourth-year veterinary student to suddenly managing cases that were sent to NC State because they were complex and difficult!
Of course we had residents and attending clinicians generally overseeing us, but it was admittedly a little “wild wild west,” and the residents and clinicians were never there quite as much as you wanted them to be.
By far, the most challenging times were our overnight emergency shifts. We all had shifts on the after-hours emergency rotations, which began Friday evening, just as we had completed our full workweek. The line between scrubs and pajamas was definitely blurred during those late nights, but we certainly gained a lot of valuable experiences.
I recall one evening during my first month as an intern when one of the long-time pharmacology professors brought in his dog who suddenly was feeling very ill. “Jimmy” was a standard poodle and normally greeted his parents by jumping up on them and prancing about the house when they came home. That Friday afternoon, they came home to find Jimmy lying in his bed, barely lifting his head to look up at them. This was such a different behavior than his typical routine that they brought Jimmy straight into the ER where Dr. Wet-Behind-The-Ears (me!) was waiting.
After the awkward pleasantries of “Hi, you’ve worked in this teaching hospital for like 20 years, and I graduated veterinary school like 20 days ago…”, I examined his dog. He had a high fever and I did notice that he had a lot of bruising in his groin. Upon further examination, there were also little small bruises and specks in his gums and even in the whites of his eyes. I quickly recognized this as “not right” and had the sinking feeling that I was dealing with a bleeding/clotting problem. We carefully drew some blood and waited for the results.
While waiting for the lab results, the professor and I made small talk and he was surprisingly kind and supportive of my naïve state. I remember when he said “I may have worked here for 20 years, but I’m a pharmacologist, not a veterinarian. You’re the doc for the night so let’s see what we find.”
That was one of those moments early in my career where I was reminded that yes, you are a veterinarian now, so start acting like one and use your head!
The labs came back and showed that Jimmy did indeed have a clotting problem, for he had, according to the lab report, exactly zero platelets.
Autoimmune Thrombo-cytopenia is a condition we see in dogs occasionally where, for some reason, their immune system starts attacking and destroying their platelets. Platelets are the first-line fighters in our clotting system. If you get a cut, it’s the platelets that quickly aggregate in the wound to initially stop the bleeding. If you don’t have enough platelets, it will take you much longer to clot if you get a cut. If you have hardly any platelets at all, you can start bleeding spontaneously. Jimmy’s bruising all along his groin, his gums, and in his eyes was a direct result of having no platelets. He was in a very serious condition.
Just as with humans, we see a lot of “autoimmune” disorders in dogs and cats. Our immune systems are one of the most complex, and most unpredictable, systems in our bodies. The immune system helps us fight off infections, but also helps our body to heal from injuries and to clean up bad cells and debris in our bodies. The immune system is awesome in its ability to seek out bacteria and fight them off. Unfortunately, this same process can sometimes mistakenly target important things like our platelets, red blood cells, and skin cells to name a few, and cause major problems.
Jimmy’s immune system, for reasons we never discovered, started attacking his own platelets until they were literally all destroyed and he was spontaneously bruising all over. The immediate treatment for Jimmy was to start him on drugs to suppress his immune system–namely steroids–while also giving him fluids and a blood transfusion to try and supply at least some much needed clotting factors his body desperately needed.
Despite my new veterinarian nerves and anxiety, Jimmy made it through the night and ultimately made a full recovery. We had to keep his immune system suppressed for many months and then slowly we weaned him off his medications, hoping his immune system would forget all about the whole platelet-destroying thing it was doing.
By the end of my one-year internship at NC State, Jimmy was alive and well and not on any medications. I had a really great relationship with his pharmacologist owner and it really felt great to talk as colleagues by the end of that year. I learned a lot about veterinary medicine, but I learned just as much about forming new relationships with people and their pets. And generally speaking, as long as I showed that I cared about the owners and their pet, and I cared about doing my best to find the answer to the problems, things would usually turn out pretty well.