2025.01.02 Thursday, 10:02 PM ・ Duration: 9 minutes 33 seconds Kim Jinkwang Participant 1 00:01 On the first day of hospitalization, albumin levels were initially low, and inflammation was significantly elevated. Looking at the current inflammation levels, they seem to be decreasing and are nearing the normal range of 20. On the first day, there was a tendency for albumin to drop after adjusting fluids, so albumin was administered, and the levels temporarily rose but then decreased again. This could be related to numerous associated conditions. One possibility is that protein loss could indicate an immune disease, so immunosuppressants were administered, and the levels improved somewhat. After scaling and anesthesia, inflammation levels slightly increased, while albumin and anemia levels also dropped. During this time, albumin was administered again, and now it has stabilized at 2.2, allowing for discharge. The anemia levels, which initially dropped, are now showing signs of recovery. Participant 1 01:25 As for the weight, it initially dropped but has now started to recover. More importantly, symptoms such as diarrhea and vomiting that were present upon arrival have improved. Vomiting nearly stopped after switching to a liquid diet, except for one instance triggered by excitement. Diarrhea also returned to normal. Considering the symptom improvement, we plan to discharge and manage at home. However, not all levels have returned to the normal range. Currently, there’s still anemia, and although albumin is at 2, it is on the lower limit of normal. We’ll need to monitor whether these levels continue to rise. Participant 1 02:23 Initially, we considered protein loss, diarrhea, and vomiting as major concerns during hospitalization. However, an X-ray revealed that the esophagus had significantly widened. Normally, food should pass directly into the stomach, but here it seems to be stored in the esophagus, potentially causing reflux and vomiting with minor triggers like lying down or excitement. During scaling, despite fasting and lying down for the procedure, traces of food gradually leaked out. Participant 1 03:43 This suggests that reflux occurred because the esophagus, particularly the lower esophageal sphincter, was not functioning properly. This could explain the continued vomiting and associated weight loss. After switching to a liquid diet, weight is gradually recovering. To further promote weight gain, it might be beneficial to increase the portion size or frequency of meals while monitoring for improvements in albumin levels. On the fifth day of hospitalization, scaling was conducted, along with neutering. The scaling successfully cleaned significant tartar buildup. Participant 1 05:04 Due to possible nutritional deficiencies, the surrounding bones and teeth appear to have weakened significantly. Some teeth with exposed roots, though stable, could not be aggressively removed due to the risk of fractures. Scaling was performed as thoroughly as possible. The marked teeth on the chart indicate those that were extracted, mostly due to tartar and exposed roots. Post-extraction, inflammation levels have significantly decreased. Participant 2 06:19 What should we do now? Participant 1 06:22 I recommend returning in a week to check the levels. If the weight and albumin levels continue to rise and anemia improves, maintaining the current medications should suffice. Otherwise, re-hospitalization or changes in medication might be necessary. Participant 2 06:53 If the levels improve and stabilize in a week, can we consider flying? Participant 1 07:00 If the levels are consistently rising, flying should be possible. Participant 2 07:08 What additional treatments will be needed? Participant 1 07:10 There’s still uncertainty about the cause of albumin loss. It could be related to issues in the intestines or kidneys, which would require invasive diagnostic procedures that aren’t feasible given the current condition. For now, we’re monitoring the response to medications and observing improvements in inflammation and thyroid levels, as well as controlling hypertension. The primary focus is on weight gain, rising albumin, and anemia levels. Monitoring the response to medication will be critical. Participant 2 08:43 It seems like there are multiple conditions at play. Participant 1 08:45 Yes, this appears to be a complex case involving multiple issues. Participant 2 08:57 Could you explain how we should feed and schedule meals? Participant 1 09:05 At the hospital, we are feeding a wet food (ID) blended into liquid form, 50ml four times a day. Since vomiting has stopped, you can either increase it to five times a day or increase the portion size to 60-70ml four times a day. Participant 2 09:28 What intervals should we follow? Participant 3 09:30 Every four hours.
The child is currently experiencing vomiting and diarrhea. To reduce inflammation, we are administering IV fluids. Since the albumin levels are low, we will recheck them today. If the levels remain low, we plan to artificially supplement albumin through IV fluids while treating the inflammation, and monitor for any improvement in condition. If the condition improves to a certain extent, we will proceed with anesthesia to address the dental issues and observe if the condition stabilizes. Veterinarian Regarding the heartworm, treatment can be risky and typically requires a prolonged period of about two to three months. Manager: Really? Veterinarian: Yes, therefore, we should discuss and decide on the treatment plan. Currently, the immediate concerns are the dental issues and low albumin levels. We will proceed with hospitalization to administer albumin and antibiotics through IV fluids to reduce inflammation, and monitor the progress. Manager: Understood. You mentioned that heartworm treatment takes about 2 to 3 months. There are options to treat with medication or injections, but the injections carry higher risks. Could the current condition be due to heartworms? Veterinarian: Yes, that's correct. Once the child's condition has fully recovered, if they are fit enough to receive the heartworm injections, that would be one treatment option. Manager: Understood. For now, we will proceed with hospitalization and monitor the progress. How long is the expected hospital stay? Veterinarian: At least 3 to 5 days.
Participant 1, 00:09 First, looking at the X-ray, this part here, which appears white, seems abnormal. When we checked the lungs with an ultrasound, it suggested some pneumonia-like symptoms. However, it might also be a residual trace from a previous pneumonia treatment. To get a more accurate diagnosis, a CT scan would be necessary to see if there’s a nodule or tumor. On the X-ray, the intestines and stomach appear full of food. At the hospital, during an ongoing examination, the stool was found to be diarrhea. Participant 1, 01:01 So the stool appears to be in a poor condition. Generally, when taking X-rays, organs should be clearly distinguishable, but due to the lack of body fat, they’re not. Everything looks white and blurred, which suggests a state of malnutrition. When the body lacks fat and is very thin, it often appears this way. Overall, the condition shows white blurriness, anemia, low hematocrit levels, and elevated platelet counts. WBC (white blood cell count), which indicates inflammation, is also high. Participant 1, 01:57 The kidney and liver function levels are normal, but the albumin level is low, which is concerning. Regarding the T4 thyroid hormone level, we checked because of weight loss, but the level is not excessively high, which would indicate hyperthyroidism causing weight loss. Instead, it is low, suggesting that the poor physical condition might be contributing to the drop. We need to monitor this further. Sodium levels are slightly elevated, which is another notable finding. Participant 1, 02:52 The notes mention that while hospitalized, the patient experienced normal bowel movements and then sudden diarrhea. During the physical examination, blood pressure was significantly high, and the ears had a lot of crusts. Microscopic examination revealed numerous ear mites. Both ears were infected with ear mites, with noticeable black crusts confirmed. The ears were cleaned. There are no significant abnormalities in the eyes or oral cavity other than gingivitis. The skin and joints also appeared normal upon examination. However, the albumin level is critically low, which can result from three causes: 1. Protein loss through the intestines. 2. Protein loss through the kidneys. 3. Poor nutritional intake leading to insufficient protein production. We checked protein loss in the urine (UPC), which showed high levels, indicating kidney-related protein loss. Participant 1, 04:53 Overall, the primary issue is the lack of protein and severely low albumin levels. This could stem from dietary issues or underlying health problems, such as intestinal or kidney issues. Notably, the patient tested positive for heartworm. Heartworm can affect the kidneys, causing protein loss and anemia. Thus, the main considerations are heartworm, kidney issues, and intestinal problems. High blood pressure can accelerate kidney protein loss. Participant 1, 05:47 Regarding the thyroid levels, it’s notable but not the primary concern. Ultrasound shows adrenal gland enlargement, potentially indicating Cushing's syndrome, which can also cause hypertension. Heart ultrasound did not show adult heartworms in the heart, although early signs could be present. There was slight dysfunction in the left atrioventricular valve, but this doesn’t seem critical for now. Participant 2, 06:44 The patient tested positive for heartworm, but are you saying it's not definitive? Participant 1, 06:47 It’s likely an early stage, so we’ll need to monitor. If heartworms become visible or a follow-up test shows a confirmed positive result, we’ll proceed with standard heartworm treatment, which includes medication and injections. For severe cases, long-term preventive medication might be considered, but since no adult worms are visible yet, preventive treatment seems appropriate for now. Participant 2, 07:48 So, we should start preventive medication since immediate treatment isn’t an option? Participant 1, 07:55 Yes, the patient’s current condition isn’t suitable for aggressive treatment. Participant 2, 07:58 What can we do right now? Participant 1, 08:03 We can start with blood pressure-lowering medication and consider switching to hypoallergenic food. Food allergies might be causing reduced absorption in the intestines. Low-protein food might also help if kidney function is involved, but starting with hypoallergenic food would be better. We can monitor the response to these changes and perform additional tests if there’s no improvement. Participant 2, 09:18 So the condition is quite severe? Participant 1, 09:23 The condition seems critical. If albumin levels drop below 2, ascites could develop. While there’s no visible ascites on the ultrasound now, further drops could lead to it. In such cases, albumin infusion might be necessary, though it carries risks of allergic reactions. Participant 2, 09:50 Does the patient need immediate hospitalization? Participant 1, 09:55 It’s borderline. Hospitalization typically involves fluids and nutritional supplementation, but infusions could worsen albumin levels, increasing the risk of ascites. I suggest starting medications and observing for 2-3 days. If the condition deteriorates, hospitalization might become necessary. Participant 2, 10:19 The patient is scheduled to fly to the U.S. on January 1. We need to stabilize the condition before the flight. What do you recommend? Participant 1, 10:19 Hospitalization could involve albumin infusion, but it’s risky. Starting medications and observing for a few days seems reasonable. If the condition stabilizes, hospitalization might not be necessary. Participant 2, 11:10 So, we’ll get the prescribed food and medication, monitor for 2-3 days, and reassess. Is that all? Participant 1, 11:10 Yes, that’s the plan for now.
2025.01.02 Thursday, 10:02 PM ・ Duration: 9 minutes 33 seconds Kim Jinkwang Participant 1 00:01 On the first day of hospitalization, albumin levels were initially low, and inflammation was significantly elevated. Looking at the current inflammation levels, they seem to be decreasing and are nearing the normal range of 20. On the first day, there was a tendency for albumin to drop after adjusting fluids, so albumin was administered, and the levels temporarily rose but then decreased again. This could be related to numerous associated conditions. One possibility is that protein loss could indicate an immune disease, so immunosuppressants were administered, and the levels improved somewhat. After scaling and anesthesia, inflammation levels slightly increased, while albumin and anemia levels also dropped. During this time, albumin was administered again, and now it has stabilized at 2.2, allowing for discharge. The anemia levels, which initially dropped, are now showing signs of recovery. Participant 1 01:25 As for the weight, it initially dropped but has now started to recover. More importantly, symptoms such as diarrhea and vomiting that were present upon arrival have improved. Vomiting nearly stopped after switching to a liquid diet, except for one instance triggered by excitement. Diarrhea also returned to normal. Considering the symptom improvement, we plan to discharge and manage at home. However, not all levels have returned to the normal range. Currently, there’s still anemia, and although albumin is at 2, it is on the lower limit of normal. We’ll need to monitor whether these levels continue to rise. Participant 1 02:23 Initially, we considered protein loss, diarrhea, and vomiting as major concerns during hospitalization. However, an X-ray revealed that the esophagus had significantly widened. Normally, food should pass directly into the stomach, but here it seems to be stored in the esophagus, potentially causing reflux and vomiting with minor triggers like lying down or excitement. During scaling, despite fasting and lying down for the procedure, traces of food gradually leaked out. Participant 1 03:43 This suggests that reflux occurred because the esophagus, particularly the lower esophageal sphincter, was not functioning properly. This could explain the continued vomiting and associated weight loss. After switching to a liquid diet, weight is gradually recovering. To further promote weight gain, it might be beneficial to increase the portion size or frequency of meals while monitoring for improvements in albumin levels. On the fifth day of hospitalization, scaling was conducted, along with neutering. The scaling successfully cleaned significant tartar buildup. Participant 1 05:04 Due to possible nutritional deficiencies, the surrounding bones and teeth appear to have weakened significantly. Some teeth with exposed roots, though stable, could not be aggressively removed due to the risk of fractures. Scaling was performed as thoroughly as possible. The marked teeth on the chart indicate those that were extracted, mostly due to tartar and exposed roots. Post-extraction, inflammation levels have significantly decreased. Participant 2 06:19 What should we do now? Participant 1 06:22 I recommend returning in a week to check the levels. If the weight and albumin levels continue to rise and anemia improves, maintaining the current medications should suffice. Otherwise, re-hospitalization or changes in medication might be necessary. Participant 2 06:53 If the levels improve and stabilize in a week, can we consider flying? Participant 1 07:00 If the levels are consistently rising, flying should be possible. Participant 2 07:08 What additional treatments will be needed? Participant 1 07:10 There’s still uncertainty about the cause of albumin loss. It could be related to issues in the intestines or kidneys, which would require invasive diagnostic procedures that aren’t feasible given the current condition. For now, we’re monitoring the response to medications and observing improvements in inflammation and thyroid levels, as well as controlling hypertension. The primary focus is on weight gain, rising albumin, and anemia levels. Monitoring the response to medication will be critical. Participant 2 08:43 It seems like there are multiple conditions at play. Participant 1 08:45 Yes, this appears to be a complex case involving multiple issues. Participant 2 08:57 Could you explain how we should feed and schedule meals? Participant 1 09:05 At the hospital, we are feeding a wet food (ID) blended into liquid form, 50ml four times a day. Since vomiting has stopped, you can either increase it to five times a day or increase the portion size to 60-70ml four times a day. Participant 2 09:28 What intervals should we follow? Participant 3 09:30 Every four hours.
The child is currently experiencing vomiting and diarrhea. To reduce inflammation, we are administering IV fluids. Since the albumin levels are low, we will recheck them today. If the levels remain low, we plan to artificially supplement albumin through IV fluids while treating the inflammation, and monitor for any improvement in condition. If the condition improves to a certain extent, we will proceed with anesthesia to address the dental issues and observe if the condition stabilizes. Veterinarian Regarding the heartworm, treatment can be risky and typically requires a prolonged period of about two to three months. Manager: Really? Veterinarian: Yes, therefore, we should discuss and decide on the treatment plan. Currently, the immediate concerns are the dental issues and low albumin levels. We will proceed with hospitalization to administer albumin and antibiotics through IV fluids to reduce inflammation, and monitor the progress. Manager: Understood. You mentioned that heartworm treatment takes about 2 to 3 months. There are options to treat with medication or injections, but the injections carry higher risks. Could the current condition be due to heartworms? Veterinarian: Yes, that's correct. Once the child's condition has fully recovered, if they are fit enough to receive the heartworm injections, that would be one treatment option. Manager: Understood. For now, we will proceed with hospitalization and monitor the progress. How long is the expected hospital stay? Veterinarian: At least 3 to 5 days.
Participant 1, 00:09 First, looking at the X-ray, this part here, which appears white, seems abnormal. When we checked the lungs with an ultrasound, it suggested some pneumonia-like symptoms. However, it might also be a residual trace from a previous pneumonia treatment. To get a more accurate diagnosis, a CT scan would be necessary to see if there’s a nodule or tumor. On the X-ray, the intestines and stomach appear full of food. At the hospital, during an ongoing examination, the stool was found to be diarrhea. Participant 1, 01:01 So the stool appears to be in a poor condition. Generally, when taking X-rays, organs should be clearly distinguishable, but due to the lack of body fat, they’re not. Everything looks white and blurred, which suggests a state of malnutrition. When the body lacks fat and is very thin, it often appears this way. Overall, the condition shows white blurriness, anemia, low hematocrit levels, and elevated platelet counts. WBC (white blood cell count), which indicates inflammation, is also high. Participant 1, 01:57 The kidney and liver function levels are normal, but the albumin level is low, which is concerning. Regarding the T4 thyroid hormone level, we checked because of weight loss, but the level is not excessively high, which would indicate hyperthyroidism causing weight loss. Instead, it is low, suggesting that the poor physical condition might be contributing to the drop. We need to monitor this further. Sodium levels are slightly elevated, which is another notable finding. Participant 1, 02:52 The notes mention that while hospitalized, the patient experienced normal bowel movements and then sudden diarrhea. During the physical examination, blood pressure was significantly high, and the ears had a lot of crusts. Microscopic examination revealed numerous ear mites. Both ears were infected with ear mites, with noticeable black crusts confirmed. The ears were cleaned. There are no significant abnormalities in the eyes or oral cavity other than gingivitis. The skin and joints also appeared normal upon examination. However, the albumin level is critically low, which can result from three causes: 1. Protein loss through the intestines. 2. Protein loss through the kidneys. 3. Poor nutritional intake leading to insufficient protein production. We checked protein loss in the urine (UPC), which showed high levels, indicating kidney-related protein loss. Participant 1, 04:53 Overall, the primary issue is the lack of protein and severely low albumin levels. This could stem from dietary issues or underlying health problems, such as intestinal or kidney issues. Notably, the patient tested positive for heartworm. Heartworm can affect the kidneys, causing protein loss and anemia. Thus, the main considerations are heartworm, kidney issues, and intestinal problems. High blood pressure can accelerate kidney protein loss. Participant 1, 05:47 Regarding the thyroid levels, it’s notable but not the primary concern. Ultrasound shows adrenal gland enlargement, potentially indicating Cushing's syndrome, which can also cause hypertension. Heart ultrasound did not show adult heartworms in the heart, although early signs could be present. There was slight dysfunction in the left atrioventricular valve, but this doesn’t seem critical for now. Participant 2, 06:44 The patient tested positive for heartworm, but are you saying it's not definitive? Participant 1, 06:47 It’s likely an early stage, so we’ll need to monitor. If heartworms become visible or a follow-up test shows a confirmed positive result, we’ll proceed with standard heartworm treatment, which includes medication and injections. For severe cases, long-term preventive medication might be considered, but since no adult worms are visible yet, preventive treatment seems appropriate for now. Participant 2, 07:48 So, we should start preventive medication since immediate treatment isn’t an option? Participant 1, 07:55 Yes, the patient’s current condition isn’t suitable for aggressive treatment. Participant 2, 07:58 What can we do right now? Participant 1, 08:03 We can start with blood pressure-lowering medication and consider switching to hypoallergenic food. Food allergies might be causing reduced absorption in the intestines. Low-protein food might also help if kidney function is involved, but starting with hypoallergenic food would be better. We can monitor the response to these changes and perform additional tests if there’s no improvement. Participant 2, 09:18 So the condition is quite severe? Participant 1, 09:23 The condition seems critical. If albumin levels drop below 2, ascites could develop. While there’s no visible ascites on the ultrasound now, further drops could lead to it. In such cases, albumin infusion might be necessary, though it carries risks of allergic reactions. Participant 2, 09:50 Does the patient need immediate hospitalization? Participant 1, 09:55 It’s borderline. Hospitalization typically involves fluids and nutritional supplementation, but infusions could worsen albumin levels, increasing the risk of ascites. I suggest starting medications and observing for 2-3 days. If the condition deteriorates, hospitalization might become necessary. Participant 2, 10:19 The patient is scheduled to fly to the U.S. on January 1. We need to stabilize the condition before the flight. What do you recommend? Participant 1, 10:19 Hospitalization could involve albumin infusion, but it’s risky. Starting medications and observing for a few days seems reasonable. If the condition stabilizes, hospitalization might not be necessary. Participant 2, 11:10 So, we’ll get the prescribed food and medication, monitor for 2-3 days, and reassess. Is that all? Participant 1, 11:10 Yes, that’s the plan for now.