9.3.2016 Emergency, South Bay, CA

Case Count: 13

This shift started with a bang - one case after another, including two euthanasias. Luckily I'm working with a good team and everything worked efficiently. Also, one of my techs routinely brings in homemade burritos, horchata, guacomole, salsa, and mango/orange juice purree. And cheesecake. Yum. 

Favorite Quotes

  • After discussing a brief delay in addressing bite wounds, "I'm going to f@#!ing kill my husband."
  • "What's with all the squirrels lately?" "Maybe it's squirrel season?" "It occurs to me that neither of us took that to mean squirrel-hunting season." 
  • "Do you have any questions?" "Nah, you talk good. We were saying you seem way on your game. I'm good."
  • "Do you see any platelets on that slide?" "Nada tostada."

4yo female spayed French Wirehaired Pointing Griffon
Dog bite wounds
     Went to a BBQ at a friend's house and the friend's two Newfoundlands decided to attack this medium-sized dog twice. The owner's husband initially said the wounds weren't bad and put her in the car to rest. We found four decent punctures and a couple of abrasions on the thorax, flank, and leg. Xrays didn't show any air or fluid in the chest or abdomen, which can happen if the puncture goes through the muscle. There was a little bit of pocketing under the skin under the bite wounds, but I decided not to place a drain. I left the wounds opoen after cleaning to allow drainage. E-collar, pain meds, and antibiotics. Good chance of healing uneventfully, small chance of complications. After discussing the wounds, the owner said, "I'm going to f@#!ing kill my husband."

2yo male neutered Domestic Shorthair (DSH) cat
Acute bloody urine and straining to urinate
     Hiding under the bed for 2 weeks due to nearby construction noise, started having trouble urinating today. Small urine spots with some blood-tinge. On exam, there was a small urinary bladder with bloody urine and no visible stones opr masses on ultrasound. Most likely cause is Feline Interstitial Cystitis (FIC, also called Feline Lower Urinary Tract Disease (FLUTD). FIC is the most common cause of urinary signs in cats, it's caused by stress, which induces inflammation (but not infection) of the urinary bladder. Since the urinary bladder usually only makes itself known to the brain when full, the inflammation gets interpreted as "full" and the cat tries to pee without producing much. The effort worsens the inflammation, and the cycle continues. Fluids and pain meds usually quiet things down, and the goal is to avoid obstruction of the very narrow male urethra, which can become an emergency problem. Urine test pending with add-on culture if bacteria noted. 

5yo female spayed Collie
Acute diarrhea
     Lethargic and having diarrhea today. Looked a lot better when she got to the hospital, which often happens with the adrenaline of an office visit. The owner declined imaging, fecal test, and fluids, but approved metronidazole, our go-to nonspecific diarrhea antimicrobial. The physical exam was fairly benign, so I'm not against this plan, but I can't comment on the risk without diagnostics. 

6-month-old female spayed Domestic Shirthair (DSH) Cat
Acute neurologic signs, continued care
     Improving, but cause still unknown. Hoping for further improvement with supportive care.

7yo female spayed Chocolate Lab
Coagulopathy, continued care
     Appears immune-mediated, so added steroids, azathioprine (immune suppressant), and Unan Baoa (herb for improved clotting). Hoping the meds and supportive care work in time for her to start producing her own cells again. UPDATE: Continued to decline, euthanized. Very sad :(

18yo male neutered Chihuahua mix
Euthanasia
     Chronic eye problems, going downhill for months, now breathing difficulty. Very sweet gentleman who spoke to the dog with cheerfully and with a smile even while crying, and well after  the deed was done. Took the remains home for burial, which I always have to advise people to take precautions to prevent other animals from accessing remains - the euthanasia solution can remain active for months. 

16yo female spayed Springer Spaniel
Euthanasia
     Losing weight and going downhill for months, now rail thin and suddenly has abdominal pain. When I was flushing the pre-euthanasia sedative, my flush needle went into the catheter port askew. When I tried to flush, the syringe popped free of the needle and sprayed a bit of saline on the dog and on the owner's nearby face. Luckily she was wearing glasses, it was just saline, and the risk of contamination is nearly zero. She was great about it, but I was mortified. Overall it went smoothly from there. 

10yo male neutered DSH
Fluid-filled mass
     Some dinner guests noticed this rather large mass (3 inches around) on this cat's right outer thigh. The owner is reasonably confident that it was not there yesterday. It contained red-tinged fluid, so I'm hoping it's a cyst, though cancer is a distinct possibility and an abscess a less likely one. Xrays showed that it did not appear to involve the bone, but it was adherent to the muscle. We drained the fluid and sent it out for analysis, started antibiotics in case we get lucky.

11yo male neutered German Shepherd
Ate 2-3 cups unsalted mixed nuts
     At first, I thought this dog was four years old. He's fit and gorgeous. But he's ELEVEN! We made him puke and the ASPCA Poison Control Hotline recommendation was to check for electrolyte disturbances. Electrolytes were normal, so we gave some fluids and sent home. I cannot overstate how much I appreciate the ASPCA Poison Control Hotline. AMAXING resource. Keep their number on your fridge.  

6yo female spayed mixed breed
Vomiting and shaking
     Vomited 7 times in 4 hours after playing at the beach. The amount of vomiting and her shaking (likely discomfort) made me worry, but the rest of her physical exam and labs were not TOO bad. She did have a high liver value (ALT), but that can happen when the liver gets knocked around by several bouts of vomiting. The owner elected symptomatic care with fluids under the skin, antacid injection, antinausea injection. He understands that I'm bugged and think something more might be at play. Hopefully she just ate something disgusting on the beach and is suffering the consequences of dietary indiscretion. 

3yo female spayed Jindo + 11yo female spayed Golden Retriever
Scuffled with a raccoon
     Only the Goden had a minor abrasion on her nose, but the owner reportedly got scratched and/or bitten by the raccoon and went to the hospital for post-exposure rabies vaccines. Both dogs are vaccinated, so the risk is low, but raccoons tend to stay away from people and pets unless there's a reason. Rabies affects mammals (all the furry, live-birth creatures), and one symptom is approaching other creatures abnormally. We did some presumptive antibiotics and pain meds for the Golden and an at-home quarantine for the dogs. Rabies can take days to years to show signs, and once the signs show, it's essentially always fatal. 

16yo male neutered Cock-A-Poo
Seizure
     History of seizures well managed on Keppra. Last seizure was in January of this year. That's a respectable interval, so we are monitoring to see if any more occur over the next 12-24 hours. If not, will go home for business as usual. This dog also has Cushing's disease and liver disease...yay!

10yo male neutered Yellow Lab
Possibly painful
     Growly and restless, possibly painful abdomen or lower back. We are giving pain meds and watching to see what develops.