8.27.2016 Emergency, South Bay, CA

Case Count: 8

My patient did much worse than expected. Respiratory cases go that way sometimes. This time I made sure to hedge and caution that this outcome was possible, but I can't shake the guilt. This was out of my control, but I always struggle with feeling responsible for setting the owner's expectations. Some situations have known odds, most don't, but it's impossible not to set some sort of overall tone. That tone - my tone - goes a long way in defining expectations, choices, and memories for my clients. If I'm too dire at the beginning, maybe they won't try, or they'll be on edge the whole time. If I paint too rosy a picture, then the devastation is compounded by the surprise. These owners, a family of three with a late-teen son, were unabashed in looking to me for guidance and showing their pain on tortured faces. It hurts to chaperone people through pain. That's mixed with my own mourning, as well as my insecurities about doing a good job. It's a lot. It's a lot.

Favorite Quotes

  • In response to a half-hearted insult - "That was an adorable effort to be mean." 
  • "When can I expect the chemistry on that patient?" "Let me check...did anybody start that chemistry?" "Yeah, I did. <stops and thinks> No. I didn't. Shit."
  • When I arrive, my colleague going off shift tells me, "I have a surgery for you. "You mean, like, a post-op case to manage?" "No. Like, a surgery for you to do. Linear foreign body. You're ok with that, right?" "Definitely."

11-month-old male neutered DSH
Linear GI foreign body
     This cat ate part of a soft toy and started vomiting. Xrays were suspicious for a linear foreign body. Strings, fishing line, ribbons, and other linear objects are delectable to cats and can cause major problems in the GI tract. If they bunch up or otherwise get anchored somewhere, the downstream intestines keep contracting and trying to push it through, so they end up "climbing" the object. The GI tract gets bunched up and keeps contracting, which can wear multiple holes in the intestines. That's bad news. Bacteria then have free access to the abdominal cavity and that's painful and potentially life-threatening. The surgery to fix the perforated gut is higher risk because you have to cut out a section of intestines and connect the ends back together (resection/anastomosis). This kitty had two separate portions of multi-color fabric cord, so I had to cut into the relatively healthy-looking stomach and the intestines to access and remove both pieces. Not ideal to make two incisions into the GI tract, but surgery went smoothly and the kitty should heal up no problem. Don't let your cats play with string, kids. 

10yo female intact Pomeranian/Chihuahua
Staples pulled out
     Put 'em back in. 

4yo female spayed Terrier mix
Xylitol ingestion
     Ate xylitol-containing sugar-free gum. Xylitol is a zero calorie sweetener that fools dog and cat bodies into thinking glucose is available. The body produces insulin, drives what little actual glucose there is into the cells, then suddenly the pet has no blood sugar at all. The brain can only use glucose (other organs can use ketones and other sources), so neurologic problems, including seizures and death, can occur. We induced vomiting, saw a bunch of wrappers, and she had no neurologic episodes overnight. Another life saved. Through puking.

9-month-old female intact Toy Poodle
Anti-coagulant rat poison
     This little dog came in for being lethargic and painful. I was able to detect only moderate neck pain, otherwise totally normal physical exam. Her owner was concerned about rat bait exposure, and only had a small amount of money, so opted for the blood test instead of xrays. Lucky dog. We confirmed the bleeding disorder and started treatment. This dog would definitely had died without treatment. 

14yo male neutered Yellow Lab
Paralyzed larynx complications
     Paralyzed larynx is somewhat common in large breed dogs. The nerve to one or both cartilages blocking the windpipe gets damaged, so the cartilages don't move out of the way during breathing. With increased breathing effort, excitement, etc, the airway can be narrowed further and breathing more difficult. This dog initially did well with sedation and oxygen-chamber therapy. Unfortunately he declined and needed to be euthanized. See above. 

7yo male neutered Domestic Shorthair (DSH)
Suspected hit by car (HBC)
     Missing for a day or so, sore when found. Xrays showed a busted pubic bone and the whole pelvis shifted forward (dislocated sacroiliac joints). Back legs weak, possibly neurologic dysfunction. Pain management, antibiotics, fluids over the weekend, surgery Monday. 

3-month-old Shih Tzu mix
Hit by car (HBC)
     This little dog escaped into the driveway and got rolled over by the owner's car. Not sure what must have happened, because at first he had rear leg pain, but became pain-free with oxymorphone. No structural problems or internal injuries noted. In growing animals, we always caution that growth plates could have been injured, so watch for stunted or abnormal limb growth. The growth plates are soft tissue at the ends of bones that have a little bony cap. When the bony cap gets sheared sideways, crushed into the end of the bone, or the growth plate is otherwise injured, the growth stops at that location. We often don't notice it on xrays because the pieces can shift back into position and look normal. Time will tell. Owner was tearfully relived not to have done horrible damage. 

12yo  female intact Pomeranian
Prolapsed uterus, complications
     Uterus, vagina, or tumor protruding from the vagina during heat cycle. Ruptured and became infected. Patient declined and arrested, ultimately euthanized. There were just a lot of things about this patient that didn't quite go together, and when that happens, cancer climbs my list.