8.26.2016 Emergency, South Bay, CA

Case Count: 18

I'm told when I walk in today that I'll be working the weekend with a consistent doctor on the opposite shift. This is usually great for continuity of care and cutting down the needed shift-change communication. I'm also told that one of our three locations will be closed for tomorrow due to lack of coverage, and the last time this happened my colleage saw 42 cases in a shift. I'm house-hunting and need to be up during daylight for an open house, cutting my sleep by half. Should be a lively weekend... 

Favorite Quotes

  • A technician uses her buttery sweet client communication voice while arranging a comfortable outdoor visiting location for a client. "Aren't you accommodating," I tease. She replies with her buttery voice, "Of course I am. Rainbows and shit." 
  • "Dr. Calhoon, is there a bug in my peach? There was a hole, so I followed it."
  • "You clearly don't love your dog," I joked. He replied, "Dude, this dog is my life. Look how photogenic he is!" 
  • "Why is Stranger Things only one season? Why? Why? Why is that? Why?"

2yo male neutered Coonhound/German Shorthair Pointer mix
Face wounds
     This EXTREMELY friendly and stunning dog bled from a mouth wound and had some scrapes after getting into a face-to-face "hello" with another dog at the dog park. I couldn't find the wound inside the right rear corner of his mouth because he was too wiggly. He had some very mild superficial wounds on his face from the other dog's teeth and on his neck from his pinch collar. His dad was a really easy-going, nice guy who let me take a picture with his dog. I thought at first that maybe this manly-man-type guy would think I was being silly, but he proceeded to show me dozens of pictures of his dog. "You clearly don't love your dog," I joked. He replied, "Dude, this dog is my life. Look how photogenic he is!" I didn't get a good shot of it, but the mostly white dog has a distinct dark brown heart-shaped patch on his back. 

6yo Domestic Medium Hair (DMH) cat
Saddle thrombus
     Suddenly yelped and couldn't use his back legs overnight. Though the owner is concerned about a possible head or back injury, the lack of a femoral pulse in both back legs, cold back legs, and complete rear leg paralysis is really a one-answer test question. The high pain level is another clue. These cases can survive, but often then die when the clot breaks down, if it breaks down, 5-10 days later and the toxins from the dead/dying tissue flood the rest of the body. This is one of the very few situations in my job where I answer people when they ask what I'd do if it were my cat. I typically turn that back around because every person has different priorities, ethics, values, beliefs, and budgets. With saddle thrombi, I always recommend euthanasia and would do so for my cat. This conversation was difficult. I nearly broke when I told him that I would, indeed euthanize my own pet in this situation. The conversation lasted a while, but the owner elected euthanasia. 

5yo male neutered DSH
Hit by car (HBC) - Air in the chest (pneumothorax), multiple broken ribs (fractures), lung bruising (pulmonary contusions)
     Very sweet, vocal cat that paws at you when you walk by and looks like mayyyyybe he's a little painful? Meanwhile, his chest looks exactly like you'd expect after going up against A CAR. Pain meds, antibiotics, make sure his respiratory function stays good. Plan to send him home in the morning for several weeks of taking it easy and healing up. 

10yo female spayed Maltipoo
Ear infection, skin infection, self-trauma, chronic skin allergies, healing incisions. Also heart disease. 
     Little white dogs often have bad skin. This one had really bad skin allergies, with inflammation everywhere and secondary inflammation in a lot of places. Her feet were so bad, for example, that she refused to go on walks. Skin allergies are a pain in dogs because they cause such a poor quality of life and they're so variable and tough to definitively diagnose that most people don't end up going through one consistent effort to arrive at a management strategy. There is no cure, only management. People want a pill...fix my dog. Skin allergies take time, they take effort, and they're lifelong. But please, please, please take itching seriously, folks. Itching is as bad as struggling to breathe or sufferinig chronic pain. It's AWFUL. And many dogs live with it for years. I'm not exaggerating when I compare it to people with such bad suffering that they consider suicide. But the dog doesn't yowl, so it's easy to ignore. This interaction was an example of how I genuinely thought that the clients and I had a meeting of the minds, but when it came time to approve the diagnostics and treatments we just spent 25 minutes agreeing on, they wanted to know why any of it was necessary. I did some good, but there's more to do. They seemed committed to visiting the dermatologist, so that's good. 

2yo male neutered Domestic Long-Haired (DLH) cat
HBC - Multiple pelvic fractures, tail fracture, and degloving wounds
     Degloving is what it sounds like - imagine skin is the glove and everything underneath is the hand. All damage appears to be to the rear end, so perhaps this cat was ALMOST across the street when it got hit by the car. The back end is weak, but gaining strength rapidly. That's good news, because it makes neurologic injury less likely. We have to express this cat's urinary bladder (empty it by squeezing...gently) because pain, inflammation, and possible nerve damage can prevent voluntary urination. Will likely go home when stable with pain medication, antibiotics, and a urethral muscle relaxer. May get surgery for wounds and/or broken bones, though many cats with pelvic fractures heal ok with just weeks of rest. 

10yo male neutered Cairn Terrier
Bit by bigger dog (BBBD) - Lung trauma, flail chest, penetrating abdominal wounds
     This dog had several of the most risky features of a BBBD. His lungs were bad to start off with, but became increasingly fluid-filled. Flail chest is when a rib (or multiple ribs, as in this case) gets broken in two places. This creates a free-floating middle segment that moves in the opposite direction as the rest of the chest - when the chest expands to draw in air, this segment and its attached muscles sucks inward, and vice versa. This makes every breath less effective, a bad combo with malfunctioning lungs. In addition, at least one of the bite wounds penetrated into the abdomen. This can mean organ damage, bacterial infection, and other severe complications. Any bite wound also carries the risk of crushing injury, where muscles, bones, organs get crunched but aren't visibly damaged. These can then die off over several days. Shaking injury can break or dislocate bones, destroy nerves or blood vessels, or separate skin from the body leaving empty space. Complications can arise up to 10 days after an incident like this. 

6yo male neutered DSH
Unable to extend right hock
     This cat became suddenly lame after a loud crash in the garage. The owners think he fell off of something. He was unable to stand up on his right rear leg, but could withdraw the leg. I determined that he couldn't extend his hock, either because of pain, muscle/tendon injury, or nerve injury. This one bugs me, and I want to find out how he does. I'll be talking to some specialists to ask their input. Pain meds and crate rest in the meantime. 

10yo female spayed Boston Terrier
Congestive heart failure (CHF), euthanasia
     Presented at the end of many months of treatment for heart failure. Maxed out on meds, no more options, her owners wanted to euthanize. She presented very close to death, with severe breathing difficulty from fluid accumulation in the lungs. We euthanized just in time, I had to hurry the process along and be less accommodating to the owners than I usually try to be.  

2yo female spayed mutt
Bee or wasp sting
     The owner's young daughter saw the dog get stung. The dog immediately went outside and vomited. That's a concerning sign, but there were no more advanced signs over the next 90 minutes. Usually life-threatening episodes progress within minutes, so an hour and a half is heartening. We gave a steroid injection and an antihistamine injection. Since the dog was so anxious, the owner elected to monitor at home. As of 8 hours later, no word, so...no news is good news? 

7yo male neutered Yorkie
Suspect a sprain or strain in the right rear leg
     This dog ran under his owner's feet at the dog park and got stepped on. He yelped, but went about his business for another 20 minutes, came home, played some more, THEN started limping. Xrays were unremarkable, nothing broken or loose on palpation, so sent home with pain meds and orders for cage rest. Since he was over 5, we did labs to make sure it was safe to give anti-inflammatories (NSAID). Yep, same class as ibuprofen, etc, but those drugs are not risk free. 

18-month-old female spayed Bernese Mountain Dog
Hit in the eye by a tennis ball
     Hit in the eye by a tennis ball thrown by the owner's young son yesterday. Today, the dog had some redness and squinting. We applied a stain to the eyes that glows under black light and saw no defects on the surface (cornea) of either eye. Sent home some pain medication, I'm expecting the inflammation to go down over a day or two.   

15yo male neutered Chihuahua
CHF and unexplained severe weakness
     This dog looks far sicker than his xrays and other diagnostics say he should. There's no clear connection between his fairly mild heart failure and his severe weakness. Whenever an older patient has seemingly unrelated problems that are out of whack with the diagnostics, I think cancer until proven otherwise. We are treating the heart failure and seeing what happens with his weakness. He is likely to be euthanized tomorrow due to running out of money. 

9yo female spayed Pomeranian
Bronchitis, continued care
     This little lady is still kicking from 8/24! Out of oxygen and looking better. She's hanging with us over the weekend because she gets too worked up when the owner is around. 

3yo male neutered DSH
Self-trauma, skin infection, fleas
     Fleas. Just treat all your cats and dogs for fleas year-round in California. They're the MOST common cause of skin problems and they're COMPLETELY preventable. Ask your vet, because no over-the-counter products are reliable, some are even toxic. For the cost of one emergency visit and treatment, not to mention months of skin disease, you could prevent fleas in the whole household. 

7yo female spayed Labradoodle
Kinda nothing
     May have eaten a small plastic baggie on a walk. The owner didn't want o come in at 3am, so just came in and had us make her puke. Nothing serious came up. Discussed signs of cannabis intoxication in case that ended up being the type of baggie, but we would expect signs fairly soon after ingestion and this pooch was symptom-free. Time will tell. 

4yo female Guinea Pig
Sniffles
     Sniffles. The owner already had antibiotics from a previous episode. I told him to continue. Another life saved. 

10yo male intact Pomeranian
Passing out (syncope) from CHF
     Same patient as two days ago, passed out while "nesting" for bed. Apparently his nesting process is very involved and he pants, humps the bedding, and gets generally very worked up. All of these things increase oxygen demand while decreasing heart and lung function - high heart rate leaves less time for the heart to fill between beats, high respiratory rate decreases breath volume. We adjusted his heart meds and will see how things go. 

4yo male neutered Border Terrier
Possible foreign body in the stomach
     This dog developed acute abdominal distension and tension. Acute abdominal pain always puts a foreign object high on the list. Xrays showed a lot of material in the stomach, even after inducing vomiting. The owner wasn't prepared to scope or perform exploratory surgery just yet, so we did fluids and at-home monitoring. Very sweet nurse practitioner owner.