8.24.2016 Emergency, South Bay, CA

Case Count: 10

I walked into work this morning and the room was full of people and pets, but silent and still other than necessary movement. A technician grabbing a syringe. Feet shifting position on the floor. I could tell something had coded. An owner stood at an awkward distance, a patient on the table with everyone surrounding and silent. I moved straight to the office pod and put down my gear. Staff silently peeled away from the case and the dog was carried into an exam room, the owner in tow. Five minutes later, new people in the exam room and a burst of loud, unknowing sobbing.  

Favorite Quotes

  • After my apology for using simple explanations with a client who is a doctor - "Why would you apologize, I don't wear a nametag that says 'doctor'."
  • To answer how many older dogs he and his wife had adopted - "Oh, we practically have a graveyard."
  • After thanking him and his wife for adopting older dogs, doing so much for them - "No, they do so much for us. We have the time and the money and the space, and, right now, the health to do it."
  • On his way out, he quoted saying, "It's like the saying 'If dogs don't go to heaven, I want to go where the dogs go'."

12yo male neutered Jack Russell mix
Anal gland abscess
     Dogs and cats have two glands next to the anus at about the 4- and 8-o'clock positions. They're the same as the glands skunks use to spray. These glands produce a foul-smelling fluid/paste that gets deposited on stool through small ducts emptying into the anal opening. When those ducts get blocked, the anal gland material builds up, causing an anal gland impaction. When bacteria are added to the mix, we get an anal gland abscess. Often, folks report a swelling and think there's a tumor. Then the thing gets angry and ruptures and bleeds and smells. Chewing, scooting, mess, and confusion often ensue. Treatment is to open up the abscess through the skin, try and unblock the duct, antibiotics, pain meds, and time. For repeat offenders, sometimes you need to remove the anal glands. Considering the delicate nature of vital nearby structures (people WILL euthanize a dog who poops uncontrollably), we push this off as long as possible. Expressing the anal glands every week or so can help keep the duct unblocked. The surgery is cool, you infuse latex or another hardening liquid so you can follow the structure and cut, cut, cut. Delicately.

9yo female spayed Pomeranian
Bronchitis, continued care
     Unchanged overall since yesterday. 

12yo male neutered Jack Russell mix
Snake bite, continued care
     Appears stable from the outside, but electrolytes are going wonky and coagulation factors bouncing around. 

5yo male neutered Domestic Shorthair (DSH) cat
Seizures AND heart arrhythmia
     A nervous cat can have a heart rate up to about 180. This cat had a heart rate at times around 350. that's fast enough that the heart may not have a chance to fill between beats, so it's like having no blood at all. patients can pass out from a heart rate that high, and die if it stays that way. In addition, this cat has been having seizures all of a sudden. Not a good outlook, but the owners are having a cardiology consultation and treating. UPDATE: Cardiologist diagnosed dilated cardiomyopathy (DCM), which is rare in cats. The heart muscle stops contracting well and enlarges. Coupled with the high heart rate, neurologic signs might be due to syncope (passing out) when oxygen stops reaching the brain. Also, blood flowing through the enlarged heart flows more slowly and clots can form. If those go to the brain, neurologic signs can develop. 

11yo male neutered Domestic Shorthair (DSH) cat
Diabetes complications
     Surprisingly low blood sugar for a diabetic. Normal for cats is 80-120. Diabetic cats can be 250-700. This cat usually hovers around 300-400, but was 160 just before breakfast, so his owner brought him in. He normalized (his normal abnormal) and went home. Big risk with diabetes is overdosing insulin and causing life-threatening low blood sugar (hypoglycemia).

11yo male neutered Pom mix
Chocolate toxicity
     Ate a large amount of chocolate, which causes heart problems and seizures at high doses. This dog, luckily, recovered. Went home after 24 hours supportive care.  

10yo male intact Pomeranian
Congestive heart failure (CHF) due to mitral valve degeneration (tricuspid and aortic valves also affected)
     Myxomatous mitral valve degeneration (MMVD) is a common cause of heart disease in dogs. The valve between the left atrium and left ventricle thickens and starts allowing backwards blood flow. Early on, this can be heard as a murmur, a squishy sound instead of a lub-dub sound. That reverse pressure builds up causes the left atrium to enlarge, which can be seen on xrays. After that, fluid accumulates in the lungs, causing coughing, weakness, and even difficulty breathing. At that stage, the heart is failing to do its job, so we call it "congestive heart failure". Treatment is basically dehydration induced with furosemide, so less fluid is available to accumulate in the lungs, so the kidneys have to be healthy. We add a drug that makes the heart contract more efficiently (pimobendan) and a drug that fools the kidneys into allowing us to dehydrate the patient (Enalapril).

1yo female spayed Terrier mutt
Ate underwear
     Very concerned, very physically imposing male owner presented this little dog for not eating. Owners found the waistband of a pair of thong underwear and suspect the dog ate the rest. Xrays were suspicious, so we induced vomiting and up came a goodly hunk of fabric. When I showed it to the owner, he was certain that that was the entire amount of missing fabric. We gave an antinausea medication so the dog wouldn't puke in his car, some fluids under the skin, and sent her home. If vomiting hadn't worked, we would have probably tried a scope under anesthesia.  

8yo male neutered German Shepherd
Abdominal bleeding, did not survive
     This older dog was adopted by an elderly couple that fosters/adopts older dogs. This big guy had a poor appetite and some lethargy last night, but became much worse today. His belly was full of blood and he arrived taking his last breaths. He died immediately and I recommended that we not try to undo that. Most likely cause is a bleeding spleen, which can happen from trauma, benign cancer, or malignant cancer. In any case, this is often how we discover it. Taking out the spleen can help in some cases, but many don't survive and others die during recovery, and about 1/3 die of aggressive cancer within 2 months. Very sweet older couple, then gentleman was a physician and I apologized for speaking in simple terms and he said, "Why would you apologize, I don't wear a nametag that says 'doctor'." I asked how many older dogs they have adopted and he said, sadly, "Oh, we have practically a graveyard." I told him thank you for doing so much for the dogs, and he said, "No, they do so much for us. We have the time and the money and the space, and right now the health to do it." On his way out, he quoted saying, "It's like the saying 'If dogs don't go to heaven, I want to go where the dogs go'."

6yo female spayed Domestic Medium Hair (DMH) cat
Ingrown nail
     trimmed the nail, no full exam. Should be fine.