Another happy ending !
A friendly, very chill cat presented to us several months ago with a broken leg. She was quite obese, and otherwise had relatively few other injuries. Her biggest problem was that she had arrived to us with a good-samaratin, who had found her outside and brought her to us for care.
She wiggled her way into our hearts with her affectionate, friendly attitude, so rarely seen from cats in the hospital. She was nearly 20lbs of purring, friendly feline love.
So, our hospital took on her care, of course, hoping to find her owner (as clearly she had not been wanting for food!), but also realizing that if they could not be located, we could save her life and find her a new family. Her leg was splinted, and we monitored healing of her fracture over the following weeks. (Ideally, surgical repair of the fracture would provide for the best outcome, however this was not feasible due to a variety of factors, including her status as a stray kitty and the unknown whereabouts of her original family).
Despite our best efforts, her leg did not heal. Nevertheless, she remained friendly, happy, and never grouchy. She purred and kneaded during her bandage changes, rolling on to her back and begging for belly rubs. She loved anyone who was willing to stop by for a few minutes and pet her. She was truly the ideal feline companion. With a soul as precious as hers, we marched forward providing the best we could for her, although still, no family had come forward to claim her. Our hospital absorbed the cost of her care, and honestly, even in these tough economic times, we were happy to do it. This kitty reminded us why we continue to pour our blood, sweat, tears, and sleepless nights into this profession -- to save pets.
About 10 weeks after her initial injury, it was determined that without surgical intervention, her leg would not be functional and would be a constant source of pain. Amputation of the broken, non healing leg was a means to provide her with comfort and an excellent quality of life. Three-legged animals are happy, ambulate well, and have no long term problems associated with the loss of their limb (regardless if the affected limb is either a forelimb or a hindlimb).
With our sweet kitty's best interests in mind, I prepared to remove her broken leg. I reviewed my anatomy, brushed up on the extrinsic muscles of the forelimb, and noted pertinent vessels and nervous structures in the path of surgery. Interestingly, the cat's forelimb is only attached to their body by muscles, ligaments, and tendons. Many cats actually have a clavicle, however it is considered "floating" and a non-functional vestige of a previous evolutionary structure. Amputation surgery requires careful pain control, balanced anesthesia, ligation of large vessels, and blocking nerve pain with local anesthetic while in surgery.
She was anesthetized, given pain medications, and her vitals monitored carefully. My staff watched eagerly as I removed her entire limb, including the scapula, and handed off the offending leg. The surgery was uneventful, and our sweet friend woke up and recovered routinely. Her scar is currently prominent, but as the incision heals and her hair grows back, it will be completely hidden from the untrained eye. She's already a pro at walking on her three limbs (she's been mostly unable to use the injured limb for the majority of the last 10 weeks, so that's actually no surprise).
Unfortunately, we have not yet located our tripod's original family. Despite this, she is on her way to being a normal kitty, and will most definitely find a new, loving household to share in her chubby happiness!
As an aside: if your pet ever has a condition requiring them to lose a limb, fear not. In the hands of a skilled surgeon, with aggressive pain control, amputation is a chance to provide pain relief, a good quality of life, and in cases like this one, a cure.
Tuesday, March 29, 2011
Sunday, March 27, 2011
I'm sad.
I actually cried tonight at work -- the first time in a long time. Of course, I've been sad, I've grieved with owners, but I don't usually cry.
A one-year old beautiful cat presented laterally recumbent, weak, cold, and with a low heart rate. I couldn't palpate femoral pulses, suggesting that her blood pressure was critically low. As I examined her, it became apparent that she had been hit by a car. An area of swelling was present over her abdomen, she was bruised, painful over her back and neck, and her nails were frayed.
Initially, she responded to stabilization with IV fluids, pain medications, and oxygen. The family allowed us to continue care and monitor her for progress, knowing the variety of possible outcomes for pets that have suffered trauma. She rallied, and became able to stand, vocalizing and resisting our attempts to take her temperature. I celebrated a bit as she had made significant strides in the correct direction.
And then, she crashed and burned. Her swelling had increased, and now, visible on x-rays, there was air accumulating under her skin and in her abdomen. Her effort of breathing worsened, and her mental status declined. She became minimally responsive.
I watched her deteriorate (and tried to intervene) over the following hour. We discussed treatment options, and ultimately, her family elected euthanasia. I cried as I gave her the injection, and although I knew that I was preventing suffering, I wished that I could save her.
I still do.
A one-year old beautiful cat presented laterally recumbent, weak, cold, and with a low heart rate. I couldn't palpate femoral pulses, suggesting that her blood pressure was critically low. As I examined her, it became apparent that she had been hit by a car. An area of swelling was present over her abdomen, she was bruised, painful over her back and neck, and her nails were frayed.
Initially, she responded to stabilization with IV fluids, pain medications, and oxygen. The family allowed us to continue care and monitor her for progress, knowing the variety of possible outcomes for pets that have suffered trauma. She rallied, and became able to stand, vocalizing and resisting our attempts to take her temperature. I celebrated a bit as she had made significant strides in the correct direction.
And then, she crashed and burned. Her swelling had increased, and now, visible on x-rays, there was air accumulating under her skin and in her abdomen. Her effort of breathing worsened, and her mental status declined. She became minimally responsive.
I watched her deteriorate (and tried to intervene) over the following hour. We discussed treatment options, and ultimately, her family elected euthanasia. I cried as I gave her the injection, and although I knew that I was preventing suffering, I wished that I could save her.
I still do.
Tuesday, March 22, 2011
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!
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!
It's like a real ER
Yesterday, we had one of the most critical patients I've ever seen arrive at our clinic.
An adult terrier mix had been attacked by a housemate. The victim had a gaping hole in his chest, and with each breath, air was flowing in to the wound. His mucous membranes were gray to purple, and he was gasping for air.
Open chest wounds are imminently life threatening, based upon the mechanics and physiology of breathing. The chest cavity maintains a pressure which is actually slightly lower than atmospheric pressure; therefore, breathing in is actually a passive process. If the chest wall integrity is lost (such as in a trauma case), the pressure equilibrates, and breathing in becomes a much more difficult task. In addition, if air is sucked into the chest cavity, the pressure inside the chest can actually become higher than the environment, resulting in what is called a tension pneumothorax. (If you've seen House, this is when he dramatically stabs someone's chest with a sharp, hollow object to relieve the pressure. DO NOT try that at home!). The ability to exchange oxygen and carbon dioxide in the lungs is one of the most critical processes in the body, and without this process, life ends within minutes.
Thankfully, both myself and the overnight doctor were in the building, as well as ample nursing staff. Immediately, we placed an IV catheter, provided him with oxygen supplementation, and covered the wound. A thoracocentesis was performed to remove excess air from his chest cavity (relieving the tension pneumothorax), and pain medications were given. Fluid support was initiated, a chest tube was inserted, and a technician focused on continuing to remove air from around his lungs. The other veterinarian and myself worked quickly to provide closure of the open chest wound, in an attempt to save the little dog's life. All of this happened in a matter of less than 15 minutes. The 10# dog had between 5-8 hands on him at any one time, trying to save his life.
We were successful in closing his wound, in providing him with rapid, life saving intervention, and although still critical and requiring much care, our little patient was in a bit of a better place.
Despite our best effort, effective teamwork, and our initial successes', the family ultimately decided that they couldn't continue treatment. He was euthanized, and passed peacefully with his family.
Monday, March 21, 2011
the (not so) immaculate conception
Clients present with a 4 year old, intact, unvaccinated female cat who is STRICTLY indoor only, and lives with no other adult cats. The queen has been in labor for >48 hours, and has a fetus currently stuck in the vaginal canal. So far, the clients note that she's delivered 5 kittens alive. (In actuality, she has 8 newborn kittens in her box at presentation).
In the exam room, the clients, who are reluctant to pay for services, note that they just can't believe she got outside that ONE time, and got pregnant.
Me: "So this is her first litter?"
Client: "No, this is her third litter."
Personally, I'm pretty amazed that getting out one time results in three separate pregnancies!
Fortunately, I was able to remove the last fetus from the birth canal manually, and no other fetuses remained. The clients grumbled about now having to find homes for 8 kittens -- I gently, but firmly, urged them to have their cat spayed, thus AVOIDING the problem.
Client: "That's a great idea!"
......I'm again, puzzled. You couldn't think of that on your own?
In the exam room, the clients, who are reluctant to pay for services, note that they just can't believe she got outside that ONE time, and got pregnant.
Me: "So this is her first litter?"
Client: "No, this is her third litter."
Personally, I'm pretty amazed that getting out one time results in three separate pregnancies!
Fortunately, I was able to remove the last fetus from the birth canal manually, and no other fetuses remained. The clients grumbled about now having to find homes for 8 kittens -- I gently, but firmly, urged them to have their cat spayed, thus AVOIDING the problem.
Client: "That's a great idea!"
......I'm again, puzzled. You couldn't think of that on your own?
Sunday, March 20, 2011
Not your average laceration.
Client arrived for me to evaluate a wound on her cat's neck, which occurred just prior to arrival. A tech gathered vitals and a brief history in the exam room, as is typical for any patient who presents at our hospital. The patient (Reeba) was 2 years old, and the client did not note any other health concerns. When I entered the exam room, I was not expecting this case: Reeba weighed about 4 lbs, was emaciated, very weak, and icteric (a yellow tint to the skin).
I started to ask questions to figure out the real story with Reeba; her appearance suggested a very chronic, long term illness that the client did not seem to recognize. The client reported that her kitty was totally normal prior to this wound, did not go outside, and was not any medications. I asked specifically what Reeba had been eating and commented on her emaciated figure. The client paused for a minute .... and finally admited that maybe Reeba hadn't been eating well for a few weeks. The client had been out of town for 2 weeks, and she thought maybe the other cat in the household ate ALL the food.
Me: "Are you sure it's only been a few weeks? She's extremely thin. Do you know how much weighed before she started to look thin?"
Client: "About 16 pounds. She was obese and my vet told me to help her to lose weight at her last checkup."
Me: "When was that, specifically? Did you have her seen by your veterinarian, so perhaps you have an exam date or some records? A few weeks seems like too short of a time to lose 75% of her mass."
The client shuffled through her paperwork, and found the exam dated THREE MONTHS prior. Reeba's mom reflected on the history, and realized maybe it had been more like 2-3 months that her appetite had seemed poor. While the client was out of town, Reeba had eaten NOTHING. The client returned home about a week ago, and started syringe feeding Reeba several days ago. The wound happened today, accidentally, when she tried to hold on to Reeba for a feeding.
Regardless of the initial cause of Reeba's illness, at this point, she was likely suffering from hepatic lipidosis, or accumulation of fat into the liver during starvation. Very simply stated, hepatic lipidosis causes kitties who were already sick to have a worsened appetite, causes nausea, and also results in liver dysfunction and icterus, as in Reeba's case. She was a very sick cat, and having lost nearly 75% of her body weight, required intensive care and diagnostics.
The client authorized bloodwork and hospitalization, which provided further evidence for severe liver dysfunction. Over the next 5 days, Reeba stayed in the hospital for rehydration, placement of a feeding tube, and careful monitoring. Reeba suffered from multiple complications of starvation, including re-feeding syndrome and skin fragility syndrome. Re-feeding syndrome is a potential consequence of eating after long periods of starvation. Reinitiating normal nutrition results in massive electrolyte changes, which can be life threatening and severe, including hypophosphatemia, hypokalemia, and hypomagnesemia resulting in weakeness, cardiac arrythmias, destruction of red blood cells, or death.
Unfortunately, due to Reeba's starved condition, she also suffered from acquired skin fragility syndrome -- which caused the initial wound and the original presenting complaint. Her skin tore with normal activity, resulting in wounds over large portions of her body. Despite careful handling, Reeba acquired new open wounds almost daily.
Reeba was discharged after about a week from our hospital, and over the following month, continued to suffer from complications related to her starvation. Eventually we lost contact with Reeba's owner. I hope Reeba had a full recovery, but I believe it is more likely that she eventually succumbed to her illness.
All of this could have been avoided if the owner had not waited THREE months to see a veterinarian about her cat's lack of appetite. I still can't grasp what she was thinking -- watching each day, as her cat skipped meal after meal and lost every ounce of muscle on her body. Imagine an average, physically fit, six-foot adult male going from 180lbs to 72 lbs over several months, and not consulting a physician. To this day, I still just don't understand if she wasn't smart enough, was in denial, was concerned about finding out bad news, or.... ????? It's beyond my comprehension.
I started to ask questions to figure out the real story with Reeba; her appearance suggested a very chronic, long term illness that the client did not seem to recognize. The client reported that her kitty was totally normal prior to this wound, did not go outside, and was not any medications. I asked specifically what Reeba had been eating and commented on her emaciated figure. The client paused for a minute .... and finally admited that maybe Reeba hadn't been eating well for a few weeks. The client had been out of town for 2 weeks, and she thought maybe the other cat in the household ate ALL the food.
Me: "Are you sure it's only been a few weeks? She's extremely thin. Do you know how much weighed before she started to look thin?"
Client: "About 16 pounds. She was obese and my vet told me to help her to lose weight at her last checkup."
Me: "When was that, specifically? Did you have her seen by your veterinarian, so perhaps you have an exam date or some records? A few weeks seems like too short of a time to lose 75% of her mass."
The client shuffled through her paperwork, and found the exam dated THREE MONTHS prior. Reeba's mom reflected on the history, and realized maybe it had been more like 2-3 months that her appetite had seemed poor. While the client was out of town, Reeba had eaten NOTHING. The client returned home about a week ago, and started syringe feeding Reeba several days ago. The wound happened today, accidentally, when she tried to hold on to Reeba for a feeding.
Regardless of the initial cause of Reeba's illness, at this point, she was likely suffering from hepatic lipidosis, or accumulation of fat into the liver during starvation. Very simply stated, hepatic lipidosis causes kitties who were already sick to have a worsened appetite, causes nausea, and also results in liver dysfunction and icterus, as in Reeba's case. She was a very sick cat, and having lost nearly 75% of her body weight, required intensive care and diagnostics.
The client authorized bloodwork and hospitalization, which provided further evidence for severe liver dysfunction. Over the next 5 days, Reeba stayed in the hospital for rehydration, placement of a feeding tube, and careful monitoring. Reeba suffered from multiple complications of starvation, including re-feeding syndrome and skin fragility syndrome. Re-feeding syndrome is a potential consequence of eating after long periods of starvation. Reinitiating normal nutrition results in massive electrolyte changes, which can be life threatening and severe, including hypophosphatemia, hypokalemia, and hypomagnesemia resulting in weakeness, cardiac arrythmias, destruction of red blood cells, or death.
Unfortunately, due to Reeba's starved condition, she also suffered from acquired skin fragility syndrome -- which caused the initial wound and the original presenting complaint. Her skin tore with normal activity, resulting in wounds over large portions of her body. Despite careful handling, Reeba acquired new open wounds almost daily.
Reeba was discharged after about a week from our hospital, and over the following month, continued to suffer from complications related to her starvation. Eventually we lost contact with Reeba's owner. I hope Reeba had a full recovery, but I believe it is more likely that she eventually succumbed to her illness.
All of this could have been avoided if the owner had not waited THREE months to see a veterinarian about her cat's lack of appetite. I still can't grasp what she was thinking -- watching each day, as her cat skipped meal after meal and lost every ounce of muscle on her body. Imagine an average, physically fit, six-foot adult male going from 180lbs to 72 lbs over several months, and not consulting a physician. To this day, I still just don't understand if she wasn't smart enough, was in denial, was concerned about finding out bad news, or.... ????? It's beyond my comprehension.
Friday, March 18, 2011
Did anyone see the train that hit me?
Sometimes, it's just chaos. This morning, I am exhausted, have a pounding headache, and feel like I got hit by a train. Honestly, I had some great cases and it was worth it. (Sorry folks, this post is a long one)
I arrived to the ER last night with four patients waiting to be seen because one trauma case had been taking precedence - as with any ER, the most critical patients are seen first.
The victim was a 2 year old golden retriever mix named Cashew who was hit by a car earlier in the day. His family did not bring him in immediately (I never understand why YOUR DOG GOT HIT BY A CAR is not an emergency, but c' la vie), they actually decided to come in because he had been vomiting blood for the last hour.
Vehicular trauma cases can vary immensely; some are killed instantly. Other cases don't even have a scratch on them -- and everything in between. Fortunately for this guy, he was on the side of not-so-bad. Chest radiographs were performed and revealed a mild pneumothorax; mild contusions were also evident. He continued to vomit blood, and when asked, the owners were unsure if there was any rat-bait on the property. Cashew appeared very stable, and had a great chance to have a full recovery and go back to his family within 24-48 hours. Unfortunately, due to the nature of car-trauma, Cashew also had the potential to worsen over the next day and require oxygen or other treatments.
His family dug in their heels. We presented them with several different estimates for care; starting with the ideal plan, and going all the way down to nothing additional to what they had already spent. They wanted to euthanize Cashew, and they told me having the potential for a sick dog was "too stressful." They'd rather euthanize.
The technician told me of the family's decision. Typically, I do not question an owner's wishes for euthanasia, however, this case was different. Cashew was bouncing in his kennel, barking, bright and happy, wagging his tail. I couldn't stomach putting him to sleep. It seemed as if his family just no longer wanted him, and therefore, the only solution was to find him a new home. We offered to take ownership of Cashew, and if he continued to do well, to find him a forever home. His family hugged me, thanked me, and had tears in their eyes as they signed the paperwork and left him with us forever. Although they didn't want Cashew any more, the silver lining is that I was able to offer them a great chance at a long healthy life with a new family. (Update; Cashew is doing amazing!)
At the same time, I had a patient who presented with vomiting and lethargy. Xrays were performed and revealed a massive amount of foreign material. After additional views and introducing some air into the patient's colon, the foreign material was confirmed to be within the large intestine -- and had a high likelihood of making it all the way out without surgery. She went home the next morning after defecating out the foreign material -- we still don't know what it was.
Various other outpatients later, and fast-forward to 4am. Two clients arrived at once; a cat who was vomiting, and a dog in labor.
The vomiting kitty was relatively stable, however dehydrated, cold, and nauseated. Her owner (Tim) was friendly, however extremely difficult. I took a look at the kitty, assessed her as ill, but stable, and stepped in to talk to the dystocia's family (a more urgent condition).
The pregnant female, TJ was in active labor. She was brought in by pet-sitters, who had been watching her all night. They had been calling our hospital for about 6 hours, completely clueless about what to watch for during whelping. A puppy had been stuck in the birth canal for about 4 hours before they finally brought her in for examination (FYI; a puppy stuck in the birth canal for > 10 minutes is an EMERGENCY). They had initially refused to pay the exam fee to have her seen.
While in the exam room speaking with TJ's agents, the owner of the cat starting ringing the bell at the front desk. OVER. and OVER. and OVER. She had seen the pregnant dog in the lobby, had exchanged some pleasantries with the other family, and knew what was going on. She had talked my assistant and knew that we were dealing with a situation, and that there was just the two of us in the building at this hour. My assistant was collecting vitals and monitoring TJ and unable to come to the lobby. Tim's cat was in the back with my assistant as well, and very stable. I opened the exam room door and asked Tim if I could help him with anything.
Tim: ".....Is there another vet here?"
Me: "No, I'm sorry. It's 4am. I am the only veterinarian in the building, and I have to evaluate the most critical situation first. I've looked at your kitty and she is sick, but stable. I'll be with you as soon as I can."
Tim: *HUGE SIGH*. "Fine. How long do I have to wait? This isn't fair."
Me: "I'm really sorry, but I am required to see the most critical, life threatening emergencies first. We'll be with you as soon as we can. I know it's very late in the night and I'm sure you are tired."
Tim was visibly irritated, but I had to return to TJ.
TJ was a sweet staffordshire mix, and was straining and straining trying to deliver her puppies. She had been in labor for about 6-7 hours and was becoming tired. Ultrasound confirmed that the 2 remaining live fetuses were in distress with low heart rates; the puppy in the canal was dead and unable to pass vaginally. A c-section was recommended, and fortunately TJs family allowed her to go to surgery.
While paperwork and getting TJ started on fluids, I returned my attention to Tim's cat. I offered outpatient therapy or hospitalization, and Tim did not seem to be able to follow a linear conversation. Example:
Me: "I can offer you some testing and hospitalization to try to figure out what's making your kitty sick, or we can just do outpatient therapy, including SQ fluids (explaining that this will help her restore hydration) and anti-nausea medications and you can see your veterinarian when they open in 3 hours."
Tim: "I want her to get nausea medication."
Repeat the above 6 times, while trying to move things along to save TJ's puppies.... the clock is ticking and each second counts....
Finally, Me: "Tim, do you understand what I am telling you?
Tim: "I want her to get nausea medication."
Me: "That's exactly what I just said. She'll get that. I need to know if you want her to stay here, with us, or go home with you and see your vet. Your kitty is very sick and really needs some testing. You need to make a decision so we can try to make her feel better. "
Tim: "She can't stay." *some mumbling about something at the regular vet that was mostly incoherent*
FINALLY. We treated the kitty as an outpatient and away she went. Her vet called me later that morning, so I know she was seen and receiving the additional care that she required.
After a lot of hard work and a few tense moments, both live puppies were retrieved during a c-section, and after a few minutes of resuscitation by my assistant, I could hear them screaming like newborns. There is nothing that can describe my joy of hearing that sound during a dystocia surgery. TJ recovered well from surgery and went home later that day.
Unfortunately, TJ will probably be in the same situation in the future as the owner refused to allow her to be spayed. Overpopulation of pets is a larger-than-life problem in the US and around the world. Of course, it's amazing to be able to provide TJ with relief from her long, difficult labor and to watch the first breaths of a newborn. It's amazing to know that we saved three lives just in that single case. As I've previously written, c-sections and delivering puppies is one of my very favorite emergencies. In this situation, it's a bit bittersweet, however, knowing that there will be more and more unwanted puppies brought into the world.
Please, please spay and neuter your pets (shout out to Bob Barker!). There's hundreds and thousands of unwanted pets living in shelters, humane societies, and rescues around the country who need homes.
I arrived to the ER last night with four patients waiting to be seen because one trauma case had been taking precedence - as with any ER, the most critical patients are seen first.
The victim was a 2 year old golden retriever mix named Cashew who was hit by a car earlier in the day. His family did not bring him in immediately (I never understand why YOUR DOG GOT HIT BY A CAR is not an emergency, but c' la vie), they actually decided to come in because he had been vomiting blood for the last hour.
Vehicular trauma cases can vary immensely; some are killed instantly. Other cases don't even have a scratch on them -- and everything in between. Fortunately for this guy, he was on the side of not-so-bad. Chest radiographs were performed and revealed a mild pneumothorax; mild contusions were also evident. He continued to vomit blood, and when asked, the owners were unsure if there was any rat-bait on the property. Cashew appeared very stable, and had a great chance to have a full recovery and go back to his family within 24-48 hours. Unfortunately, due to the nature of car-trauma, Cashew also had the potential to worsen over the next day and require oxygen or other treatments.
His family dug in their heels. We presented them with several different estimates for care; starting with the ideal plan, and going all the way down to nothing additional to what they had already spent. They wanted to euthanize Cashew, and they told me having the potential for a sick dog was "too stressful." They'd rather euthanize.
The technician told me of the family's decision. Typically, I do not question an owner's wishes for euthanasia, however, this case was different. Cashew was bouncing in his kennel, barking, bright and happy, wagging his tail. I couldn't stomach putting him to sleep. It seemed as if his family just no longer wanted him, and therefore, the only solution was to find him a new home. We offered to take ownership of Cashew, and if he continued to do well, to find him a forever home. His family hugged me, thanked me, and had tears in their eyes as they signed the paperwork and left him with us forever. Although they didn't want Cashew any more, the silver lining is that I was able to offer them a great chance at a long healthy life with a new family. (Update; Cashew is doing amazing!)
At the same time, I had a patient who presented with vomiting and lethargy. Xrays were performed and revealed a massive amount of foreign material. After additional views and introducing some air into the patient's colon, the foreign material was confirmed to be within the large intestine -- and had a high likelihood of making it all the way out without surgery. She went home the next morning after defecating out the foreign material -- we still don't know what it was.
Various other outpatients later, and fast-forward to 4am. Two clients arrived at once; a cat who was vomiting, and a dog in labor.
The vomiting kitty was relatively stable, however dehydrated, cold, and nauseated. Her owner (Tim) was friendly, however extremely difficult. I took a look at the kitty, assessed her as ill, but stable, and stepped in to talk to the dystocia's family (a more urgent condition).
The pregnant female, TJ was in active labor. She was brought in by pet-sitters, who had been watching her all night. They had been calling our hospital for about 6 hours, completely clueless about what to watch for during whelping. A puppy had been stuck in the birth canal for about 4 hours before they finally brought her in for examination (FYI; a puppy stuck in the birth canal for > 10 minutes is an EMERGENCY). They had initially refused to pay the exam fee to have her seen.
While in the exam room speaking with TJ's agents, the owner of the cat starting ringing the bell at the front desk. OVER. and OVER. and OVER. She had seen the pregnant dog in the lobby, had exchanged some pleasantries with the other family, and knew what was going on. She had talked my assistant and knew that we were dealing with a situation, and that there was just the two of us in the building at this hour. My assistant was collecting vitals and monitoring TJ and unable to come to the lobby. Tim's cat was in the back with my assistant as well, and very stable. I opened the exam room door and asked Tim if I could help him with anything.
Tim: ".....Is there another vet here?"
Me: "No, I'm sorry. It's 4am. I am the only veterinarian in the building, and I have to evaluate the most critical situation first. I've looked at your kitty and she is sick, but stable. I'll be with you as soon as I can."
Tim: *HUGE SIGH*. "Fine. How long do I have to wait? This isn't fair."
Me: "I'm really sorry, but I am required to see the most critical, life threatening emergencies first. We'll be with you as soon as we can. I know it's very late in the night and I'm sure you are tired."
Tim was visibly irritated, but I had to return to TJ.
TJ was a sweet staffordshire mix, and was straining and straining trying to deliver her puppies. She had been in labor for about 6-7 hours and was becoming tired. Ultrasound confirmed that the 2 remaining live fetuses were in distress with low heart rates; the puppy in the canal was dead and unable to pass vaginally. A c-section was recommended, and fortunately TJs family allowed her to go to surgery.
While paperwork and getting TJ started on fluids, I returned my attention to Tim's cat. I offered outpatient therapy or hospitalization, and Tim did not seem to be able to follow a linear conversation. Example:
Me: "I can offer you some testing and hospitalization to try to figure out what's making your kitty sick, or we can just do outpatient therapy, including SQ fluids (explaining that this will help her restore hydration) and anti-nausea medications and you can see your veterinarian when they open in 3 hours."
Tim: "I want her to get nausea medication."
Repeat the above 6 times, while trying to move things along to save TJ's puppies.... the clock is ticking and each second counts....
Finally, Me: "Tim, do you understand what I am telling you?
Tim: "I want her to get nausea medication."
Me: "That's exactly what I just said. She'll get that. I need to know if you want her to stay here, with us, or go home with you and see your vet. Your kitty is very sick and really needs some testing. You need to make a decision so we can try to make her feel better. "
Tim: "She can't stay." *some mumbling about something at the regular vet that was mostly incoherent*
FINALLY. We treated the kitty as an outpatient and away she went. Her vet called me later that morning, so I know she was seen and receiving the additional care that she required.
After a lot of hard work and a few tense moments, both live puppies were retrieved during a c-section, and after a few minutes of resuscitation by my assistant, I could hear them screaming like newborns. There is nothing that can describe my joy of hearing that sound during a dystocia surgery. TJ recovered well from surgery and went home later that day.
Unfortunately, TJ will probably be in the same situation in the future as the owner refused to allow her to be spayed. Overpopulation of pets is a larger-than-life problem in the US and around the world. Of course, it's amazing to be able to provide TJ with relief from her long, difficult labor and to watch the first breaths of a newborn. It's amazing to know that we saved three lives just in that single case. As I've previously written, c-sections and delivering puppies is one of my very favorite emergencies. In this situation, it's a bit bittersweet, however, knowing that there will be more and more unwanted puppies brought into the world.
Please, please spay and neuter your pets (shout out to Bob Barker!). There's hundreds and thousands of unwanted pets living in shelters, humane societies, and rescues around the country who need homes.
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