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Black Death

Posted Sep 17 2012 10:00am
Earlier this month, a young Colorado girl was diagnosed with bubonic plague. Yes, plague — as in the Black Death. Thankfully, she’s recovering well, but the story reminded me of one of my favorite tales from the trenches of veterinary medicine.

Staying on top of medical advances or just refreshing your memory about diseases you don’t see all that often is part of being a doctor. Conferences play a role and so do the many journals that are sent our way every month. I’m sure I’m not alone in constantly having a stack of them that need my attention. Honestly, the last thing I want to do after a full day of seeing patients is to sit down with a veterinary journal, so I have developed some creative ways to keep the pile down to a manageable level. I tend to keep a few beside the toilet … enough said.
 

Anyway, back when I was practicing in Wyoming, I had used some bathroom time to read through an article about plague in cats. My take home message was something along the lines of, if you see a REALLY sick cat with a high fever and swollen lymph nodes, don’t forget about plague.

Fast forward a week or two, and another veterinarian in my practice was struggling to diagnose one of her patients. This cat was going downhill fast, and Sarah was starting to worry that she was running out of time to get to the bottom of things. She pulled me aside and asked if I would mind taking a look at the cat and putting in my two cents worth. I was happy to help but doubtful I would have much to offer since Sarah is an excellent and thorough veterinarian.

I started out by performing a physical. I could feel the heat radiating off of the cat before I even laid hands on him. He had a temperature of 106°F. I palpated his submandibular lymph nodes (the ones that are located between the base of the jaw and neck). They were huge. I thought, "Hmm … it couldn’t be. We don’t have plague around here." Then I picked up the chart and read through the cat’s history: outdoor cat, big hunter of mice, from a ranch located almost 100 miles to our southeast where plague was, if not common, at least not unheard of.

I walked over to Sarah and said, "You know, I think he might have plague." She looked at me as if I had just claimed that I had an alien locked in my closet, but after I explained how I had been reading a journal in the bathroom a couple of weeks back (that didn’t faze her, I suspect she’s done the same) and the cat’s symptoms and history fit really well, she got excited. We sent the requisite samples to the lab and began treatment immediately. The cat was much better by the time we received confirmation of the diagnosis. We also had the cat’s owners and our staff talk to their doctors about potential exposure. To be on the safe side, everyone was put on antibiotics.

Now, whenever I’m tempted to toss a journal into the recycle bin before at least flipping through it, I think of this case. A cat survived and a few people potentially avoided serious illness, all because I spent a few minutes "multitasking."
 
 

Dr. Jennifer Coates
 
 
Image: Plague mask from last Danish plague / via Alchemipedia
 
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