Percardiocentesis - a big word. You'll know what it means by the end of the post.
The phone rings at 6:00 AM. "I didn't mean to wake you". [How could I answer the phone if I weren't awake?] It turns out that Coco had had a tough night. So had her folks.
I had seen her the day before. Coco is a little Poodle, around eleven years old, weighs 18 pounds, has always been pretty healthy. She had come in for her annual check-up, no problems... well, she'd been coughing a little, and seemed to breathe heavily, but just in the last few days. When we X-rayed her chest, her heart looked like a basketball. Ultrasound (echocardiogram) revealed a normal heart inside a pericardial sac filled with fluid -- a LOT of fluid. Coco's folks said that referral to the specialists in Memphis was out of the question. When I consulted with the cardiologist by phone, he felt that since Coco wasn't in much distress, we didn't need to have the folks make an emergency trip back for drainage of the fluid. "Don't wait 'til next week, though." As it turned out, waiting overnight had been a bad idea.
Her breathing was much more labored this morning. It was obvious that she would be moving to the front of the line. The heart is normally surrounded by a membranous sac containing a small amount of fluid to lubricate the heart surface so that it's not rubbing on things as it beats. This pericardial sac had to be drained. In twenty-nine years of practice, it was my first time. I've done similar procedures to remove fluid from the abdomen and chest, but poking around the heart is a bit more delicate. There's a great description of "how to do it" in Ettinger's Textbook of Internal Medicine. How'd you like to have your family doctor poke a big needle in your chest after "reading up on it a little"? The cardiologist also gave me some pointers, and I had the ultrasound to help guide me. It went fine, and after removing 5 ounces of fluid from around her heart, Coco immediately felt better. She trotted out of the clinic like a puppy.
The bad news is, the source of the fluid is probably a tumor. It's hard to say how soon the fluid will return, but we're pretty sure it will. Even if her owners were up for a big exploratory chest surgery (and they are not), the outlook is pretty grim. We'll just hope for some happy days in the meantime.