sometimes, things go well

Today was a great day -- which had the potential to be a disaster.

A 13 year old chow mix presented today with signs consistent with GDV - which is actually considered "the mother of all emergencies."  The dog, "Tuscon" was extremely weak, unable to walk, tachycardic, and had poor pulse quality, as well as classic severe distention of his abdomen.  He had been retching unproductively at home and had been worsening over the last 30 minutes.

A blood pressure was measured at 60mmHg, a critically low level, resulting in poor perfusion of internal organs, development of metabolic derangements, and if left untreated, potential for death.

Immediately, an IVC catheter was placed and bolus fluids were initiated. He was provided with pain medication and oxygen, and blood samples were collected for analysis.  I spoke with the family and recommended emergency treatment, including stabilization, fluid therapy, confirmation of my diagnosis (with a radiograph), and then emergency surgery to decompress, derotate, and pexy the stomach to the body wall.

Initially, the owners were reluctant to allow treatments as they had no ability to finance care.  They wanted surgery to be performed, however a GDV surgery typically costs between $2000 and $4000 depending upon patient factors, recovery time, etc.  This is obviously a huge financial investment and difficult for many of us to come up with on the spot. (Yet another reason to start that pet savings account I discussed previously)

Also contributing to the potential for a bad outcome in Tucson's case was his advanced age, his poor blood pressure, and the potential for concurrent age-related diseases.  His family and I discussed the risks of surgery, and that without immediate treatment, Tucson would succumb to his illness.  The only option other than surgery for Tucson was, unfortunately, euthanasia.

Tucson was a very well loved dog, and he had a dedicated family - they were able to quickly reach a friend who could help them finance Tucson's care.  Tucson received hetastarch, his stomach was decompressed by trocharization, and his blood pressure improved.  He was anesthetized and prepared for surgery.

Tucson's family and I had discussed the increased risks of anesthesia and surgery in his case; however due to our treatment interventions, careful monitoring, proper drug selection and just a little bit of luck, Tucson performed very well under anesthesia.  His stomach was easily replaced back to its normal position, and had little evidence of damage from the previous severe dilation.  Tucson did suffer from one additional complication of GDV: his spleen had torn, resulting in hemorrhage.  The tear could not be repaired, and his spleen was removed.    His family was ecstatic to hear his progress after surgery; despite his advanced age, critical condition, and all the potential complications, he had done very well.  

Sometimes, things just go well.  Thank goodness for that!