"Leo," a 18 year old gray tabby cat, presented for bleeding from his mouth. He had otherwise been a previously very healthy cat. Leo was indoors only, so trauma was very unlikely. As I to take a detailed history from his concerned owner, I began my full nose-to-tail physical exam. My standard physical exam is performed the same way every time, in the effort to be the most efficient and to avoid forgetting any sections of the body. I start at the patient's head, with ears, eyes, nose, throat first, then moving to an oral exam, followed by listening to the heart and lung sounds, palpating the abdomen, and finally evaluating the extremities, performing a neurologic exam, and a rectal exam.
Leo's diagnosis was visible before I even left the first segment of his exam. An expansile, large fleshy mass was present at the base of his tongue, and clotted blood was present where he had likely bit the tumor, resulting in the symptoms noted by the owner. Unfortunately, given the size and location of this mass, Leo's options would be limited, and the client instantly knew this when I gave him the sad news.
A 2 year old dog had arrived and was brought in on a stretcher. The 160lb Rottweiler was stumbling, and acting bizzare, according to the owners. Immediately on examination of "Gus," his diagnosis was unmistakable. Gus was headshy, and when left alone, would fall alseep. He could walk, but had a drunken, ataxic gait. He was dribbling urine - all hallmark signs of marijuana toxicity. His clients, with red, bloodshot eyes, wearing Bob Marley apparel (I'm not exaggerating!), and smelling of Mary Jane, claimed that it was completely impossible for Gus to have had access to pot. "No way, man," they claimed.
I tried to explain to them that my only interest is in the health of their pet, and if there really was no access to THC, then we needed to be aggressive about determining the actual toxin or process responsible for Gus' symptoms. I offered drug testing, antifreeze testing, and a biochemical panel to evaluate internal organ function. After reviewing costs, the clients declined testing, and requested treatment for THC.
The next patient to require my attention was a 5 year old orange tabby who had just been closed in a garage door. Fortunately, the friendly, fat kitty had only suffered some minor brusing and soft tissue injury of his pelvic region, and radiographs ruled out pelvic fractures. He'd be back to chasing mice in no time.
The day rolled on, and the rest is to be continued....