Tuesday, February 14, 2012

Saved two birds with one stone

It's not every day that my diagnosis saves TWO lives.

Last weekend, a 15 year old cat arrived at the clinic for evaluation.  His clients rushed in the front door, stating that he had been attacked by their 2 year old boxer. 

The patient, "Stewart" was tilted to the right, with frequent eye movements (nystagmus) and meowing.  He could not stand, but could move all four of his legs.  We placed an IV catheter, and gave him oxygen.  I looked over his entire body, and I found dirty ear canals, dental disease, and a cat who could not stand, but nothing to support a trauma event.  No saliva, no open wounds, no fractured legs, no blood, nothing.

I went into the exam room to discuss the history in more detail. 

"What happened tonight?" I asked. "Did you see Stewart get attacked by your dog?"

"No," the clients said. "We heard no scuffle, no indication of a fight, but all of a sudden, while Stewart was in the other room, we heard him start meowing loudly.  When we went to go see what was going on, he was like this."

I smiled, realizing that this was a case of a wrongly accused boxer.

Stewart's clinical signs included brown foul smelling discharge in both ears, a head tilt, inability to stand, especially falling to one side, and nystagmus.  These symptoms point to dysfunction of the vestibular system, which is the part of the brain responsible for balance.  Common causes of this include stroke, inner ear infection, blood clot, or brain tumor.  Trauma is a possible, but much less likely cause, given the cat's indoor only status and the specific nature of the symptoms.

I discussed with the clients these facts.  They simply could not believe that the boxer was not responsible.  Apparently, he had been known for rough play, and was responsible for an accidental broken limb of their other pet about 6 months prior.  Again, I poured over the cat, looking for any evidence of injury. I found nothing.  I looked at his ear debris under the microscope, and found a raging infection.  I took radiographs and found again, nothing.

The clients started to take a deep sign of relief. Inner ear disease is treatable, and the most likely cause of the symptoms for Stewart that evening.

 With tears in their eyes, they earnestly told me, "Doc, you've just saved a boxer's life tonight. We didn't want to have to put him down for his behavior, and now you've helped to prove that he probably wasn't responsible for Stewart's illness.  Thank you so, so much."

Friday, February 10, 2012

Emotionally drained.

This week was long and frustrating.  Case after case came in with $20 or less available to fix life threatening illnesses.  As you all know, veterinary care isn't free; in fact, nothing in life is free.  I can't count the number of times I've been called names, yelled at, or told that I don't even care about animals, and the reality is that those statements couldn't be further from the truth.  It hurts each and every time I have to deny an animal care it needs - because it's never the animal's fault.  We do what we can to provide affordable care, but unfortunately like any small business, we have to be able to pay our employees, pay for our equipment, electricity, water, rent, restock our shelves, and at the end of the day, be able to pay our own personal mortgages, school loans, and afford food.  There's a very, very small limit to what we can do without payment.  This isn't a matter of loving animals enough - it's a matter of the costs of keeping a business running.

Unfortunately, when faced with this, some of my clients turn into an extra-special form of nasty.  Personal choice involving money are a complicated and emotionally charged issue, and I am definitely no expert in sociology or economics, however I can point out a few especially frustrating observations:

1.  Don't call me a money-grubbing asshole if you are driving a new Lexus SUV (Mercedes, BMW, etc), wearing more diamonds on your hands than a small country's worth, and carrying a Prada bag. You  have chosen to spend money on other (ridiculously unnecessary!) things, and it is NOT MY FAULT that now you have terrible credit.

2.  If you think of your dog/cat as "your child," and you then why did you notice that it stopped eating and started vomiting TWO WEEKS ago, and do nothing about it until 2am tonight, when your dog/cat is unable to move, and in critical condition?

3.  Don't try to guilt me into treating your pet for free because you paid your taxes this year! (Someone actually stormed into my office and demanded care with the statement "Where does my f***** tax money go, anyway"!!!) Veterinary hospitals are not owned, operated, or supported by government funds!

4.  If your friends, family members, neighbors, and multi-million dollar credit card companies refuse to let you borrow money, then how can you possibly expect my clinic to take on that risk?

5.  If you choose to do drugs, whatever.  If you choose to drive yourself to our clinic, high on heroin, and demand free care, whatever.  HOWEVER, if you do these above two things and bring a CHILD with you.... you can bet your ass I'll be calling the police to pick you up and take that kid away from you, you sick evil bastard.

6. (Unrelated to #5) I'm sorry, I can't hold your child (yes, adult human child) for collateral.  Don't even bring it up again, or I'm calling the police.

7. Furthermore, no, I can't pawn your clothes and jewelry.  I'm a doctor, not a pawn-shop owner or a consignment shop.

These are just a few examples of the depths to which people can sink when they feel trapped.  Don't get me wrong, I empathize with anyone who is in a crisis with limited resources, however as the recipient of the nastiness, it gets really hard not to take it personally.  There's only so much a person can take, and in the ER, we get way more than our fair share.

It's been a full week filled with this emotionally draining, burn-out producing crap, and I'm ready for a new leaf.  Here's hoping for a good weekend at work.


Thursday, February 2, 2012


Everyone, spread the word.  Bloat kills. Any owner of a deep-chested at-risk breed should know the signs and symptoms.

Tonight, a young, intelligent client called.  "My dog has a distended abdomen, and he's trying to vomit.  This has been going on for three hours.  What can I give him?"

My tech immediately, and directly informed the man that this is a critical emergency, and that his dog required IMMEDIATE medical attention. 

The client arrived, and his dog was already deceased.  We attempted CPR, to no avail. 

His dog was only 9 months old, and if he had come in when he first noticed the problem, we could have saved her. The saddest part is that I saved her after being hit by a car only 4 months ago, and now this.

I know I've posted on GDV before, and I know that sometimes, if you aren't home, there's nothing you can do.  But if you ARE home, don't wait.  These symptoms require IMMEDIATE action, or it's quickly too late.

Spread the word, save a life.

The things we do....

A few days ago, I saw a 2 year old male cat for straining to urinate. After a physical exam, he was quickly diagnosed with urethral obstruction, a life-threatening emergency and a common problem in emergency medicine.  I spoke with the client, a woman in her 50's who was acompanied by a child.  At first, I thought the kid was poorly behaved; he beat on the doors, screamed, slammed the chair into the walls, and made it nearly impossible for me to speak to the client.  His yelling was louder than I am capable of speaking, and many times I stopped, waited for a pause in the yelling, and then would continue.  After a few minutes, I realized the child likely was autistic, not poorly behaved.  I tried to be as understanding as possible however his activity made discussing the situation with the client very, very difficult.

Urethral obstruction in male cats is a complex process.  Many times, urethral obstruction is due to a build up of crystals in the urinary bladder, urethral spasm, and blood clots that form a plug in the urethra.  Inability to urinate quickly results in pressure on the kidneys, causing build up of dangerous toxins, electrolytes, and eventually, if left untreated, kidney failure and death.  More information is available at veterinary partner.

The treatment for urethral obstruction is pain control, resolution of electrolyte abnormalities, and anesthesia in order to pass a urinary catheter and relieve the obstruction.  Cats should remain hospitalized for 24-48 hours, depending on the duration and severity of their condition to allow urine to be flushed, kidneys to be healed, and to decrease probability of a second obstruction.  Urethral obstruction can reoccur, and often cats who experience this condition will be placed on a prescription diet, or a canned food-only diet.  Some cats experience multiple obstruction episodes and require surgery to enlarge their urethral opening.

The client began to cry, and her autistic son began to scream.  "I don't have any way to pay for this" she said.  "The cat helps my son, and I just don't know what to do. There's nobody who can help me. I just can't let him go."

The preferred medical treatment was out.  I had to find a way to help this kitty with a budget that could barely cover the exam fee.

I gave the kitty pain medication, and emptied his bladder with a small needle and syringe to relieve the pressure.  I applied a local numbing agent to his penis, and then attempted the impossible- catheterizing an awake cat.  This method is not recommended, as it is painful and usually unsuccessful.  I'm sure most of you can imagine trying to even touch a cat when they don't want you to.... add on top of that, trying to insert a catheter into a cat's penis!  Nevertheless, I had to give it a try, for if I couldn't find a way to unblock this kitty, he would face certain euthanasia. 

I discussed with her the risks of this, and we discussed euthanasia as well.  While her autistic child screamed, she cried, explaining to me how this cat helped her son cope with his disability. I couldn't bear not giving the cat a chance.

We attempted the procedure, and fortunately, were successful.  I sent them on their way with medications, instructions, and strict monitoring parameters.  She called me 3 weeks later to let me know that despite the odds, her kitty had not required further care, and our willness to help her had saved her cat's life.  She thanked me, and I knew we had done something very important for her family.

Wednesday, February 1, 2012

The true meaning of irony.

These two cases still make me giggle. You'll soon see why.

A client called, screaming into the phone. " I'm coming with my dog, RIGHT NOW!" Before my technician could ask her what was wrong, she hung up.

20 minutes later, a car comes tearing into our parking lot, headlights flashing, brights on, honking her horn like a crazy person. My techs are already on their way outside when the client flings open her door, screamng hysterically. In the process, she manages to scratch the bejesus out of the car next to her. "He's dying, he's dying!!!" She screams.

My tech takes a look, obviously concerned that this pet might be critically injured. While performing a brief evaluation and carrying the pet inside, my tech starts to get a patient history. "What happened? Did he get by a car, or...?"

The dog cannot walk well, is ataxic (means literally 'without axis,' or off balance), stumbling, and hypersensitive to noise and sound. He overreacts with any sort of stimulus. His mucous membranes are pink, his pulses are strong and his heart rate and body temperature are slight slowed. He's also dribbling urine.

It becomes clear that this dog is definitely not dying..... He's stoned.... and so is his owner.

We notify the owner of the other car, and I talk to the client about her pet. Shockingly, it is revealed that marijuana is in the household. I offer testing to confirm my suspicions, but also let her know that her dog is likely to be fine by the morning.

Even she laughs a little about the way she arrived, and the other car she scratched

Case number two:

A 3 year old, otherwise healthy doberman presents for suddenly being unable to walk. She was fine when the family left for work, and upon arriving home, was in this state. The dog, "Lizzy" was brought in on a stretcher. Her heart rate was slow, about 60 beats per minute, but her pulses were strong. Her body temperature was low, and she was mostly non-responsive, however if startled, would completely over-react, flail and panic, then return to her near coma state.

Lizzy had been in a kennel all day, but prior to the clients leaving for work, she had been outside, out of sight. No known toxins were available, but based upon her history, some sort of toxicity was still the most likely diagnosis. Her family authorized all testing, including antifreeze testing (negative) electrolytes, blood sugar ( normal) and urine drug screening.

Can you guess what she got into?

Yes, that's right. Marijuana. I had a suspicion from the inital symptoms, however her family swore up and down that couldn't be possible. They also didn't seem like 'the type,' but you just never know.

I saved the drug test cartridge and took it with me as proof to show the clients. This was good news, as marijuana poisoning, even severe exposures, are very treatable.

The clients looked at me and listened. When I showed them the positive drug test, they laughed incredulously.

"Do you know who I am or what I do for a living?" The female client asked.

"No, I'm sorry, I have no idea. Should I know?"

"I'm the chief of police!" She laughed, almost too hard. "And I have a stoned dog!!!!!"