All Work, No Play

I missed out on the Rural Hill trial last weekend. Four out of six doctors were at a continuing education event in Raleigh, and as a new grad I don't need CE this year, so I had to stay behind at work. I was really bummed.

So was Rae.

On Friday and Saturday there were times when I was the only doctor in the hospital, as the other had to run out to some farm calls. And on Saturday evening and all day Sunday I was on-call with a college student to help me. It figures that during those times I saw some difficult cases: a dog with retinal detachment in one eye and glaucoma in the other, a dog with a pyometra, a kicked-by-cow cattle dog, a vestibular dog, and a seizuring dog. There was a fading puppy, a chihuahua who weighed 0.4 lbs at one month of age, had a huge open fontanel (hole in skull where the bones don't fuse), heart murmur, pneumonia, and constipation. There was a pyrenees who was found under the porch foaming at the mouth and unable to get up. It came to the clinic and was very neurologic as we tried to examine it. The dog became maniacal; luckily we'd gotten a muzzle on it. It was flinging foamy saliva everywhere, biting and chewing at every inanimate object in sight, and becoming violent towards us. It was screaming and thrashing about in response to me grabbing it's tail in order to take it's temp. He was falling all over himself, knuckling, getting stuck in the corners and hung up on table legs. I was scared, and it was only me and my one helper at the time, who was also freaked out. The owner was likely high and was completely oblivious. The dog had a questionable rabies vaccine history, so we decided to put it in a stall in the barn and just let it alone. Long story short, on the 3rd day it was almost normal, just dazed and disoriented. I gently asked the owner if it could've gotten into any perscription drugs, toxins, or any illicit drugs (I said something about neighbors so as not to imply anything) and he sort of chuckled. I'm pretty sure the dog ate some pot, it fits the clinical picture perfectly (rabies did, too, except that it got better). When the other doctors got back they told me that if I'd known about this client, I'd have probably suspected drugs before rabies. Ha. They did get a kick out of the fact that I'd seen pot dogs come through school; we even have drug tests in the Emergency Service.

I also had to see a paralyzed dachsund who'd been through 3 back surgeries already and who hadn't peed in a day. The folks weren't from around here, so essentially they just wanted me to express the bladder and give them pain meds til they got the dog back to it's neuro vet. The little doxy was so tense that I couldn't palpate a bladder, so I put an ultrasound probe on it, found the bladder, and guided a needle into it's abdomen and then into the bladder to suck out the urine. I'm not sure how I had the guts to do that, as I've *never, ever* done that before. But I was on my own, so I had no choice. I was soooo relieved to see that syringe fill up with urine as I pulled back!

So not impressed.

Then, while I was placing a drain in the side of coon hound after I'd pulled out a wad of black, stinky pus, a receptionist came back to tell me there was a lab trying to die in the waiting room. I went to see the lab and it was pretty much flat out. It could barely walk, so I took it straight back to a treatment room. The dog was completely fine the night before, but had gotten into the trash that morning. I did a PE and found that the dog was pale, had a low temp, was really weak, and was breathing hard. I ran some blood work and nothing was obviously wrong. The red blood cell count was low, but not as low as I'd expected it to fit with how sick the dog was. I figured the dog must be bleeding somewhere...chest was lower on my list since the lung and heart sounds were fine, but if it ate rat poisoning that's where I'd expect bleeding. Abdomen was on my list, since I was thinking it may have eaten something sharp, though that shouldn't cause the dog to bleed out. Pancreatitis crossed my mind since that often results from trash-eating. I decided to go with a "chabdomen" series of radiographs...the girls hadn't heard that one before (chest + abdomen = "chabdomen"), but it gave me a partial view of the chest and most of the abdomen. The lungs were clear but the abdomen was filled with blood. There weren't any signs of a metallic or bony foreign body, but the small intestines were pushed off to the side due to an enlarged spleen. That's when it became clear to me...splenic hemangiosarcoma rupture. This had popped into my head while I was waiting for the x-rays to be developed, and as soon as I had the first film on the viewbox and saw a belly full of blood, I knew that's what was going on. I remembered seeing a lab that looked just like this at school. It was flat out in the Emergency treatment room and had gone from normal, happy lab to almost dead in a matter of a couple hours. Upon further questioning, the owners reported that this dog's mother had died of "splenic cancer." This dog had a mild episode similar to this about a year ago, which was possibly a small bleed that clotted, allowing the dog to resorb the small amount of blood in its belly. Splenic rupture is a very unfortunate thing for owners to experience; many times dogs are just found dead.

This was the first time I had to deliver bad news to owners. Livestock people, they just accept it as a part of the business, but pet owners, that's an entirely different audience. I showed them the x-ray and explained what was going on. It seems the trash incident was a red herring. I offered sending them up to Tech, but was up front with them in that they could spend a lot of money and do everything medically possibly to try to save the dog, and it likely wouldn't be enough. He needed surgery to remove the spleen, yet he was in no condition to go to surgery, he'd most certainly die on the table. I offered keeping him at our hospital and doing our best to nurse him along, transfusions, supportive care etc, though that would only be a temporary fix. He might make it a week, a day, or maybe an hour. I offered euthanasia, which is a difficult thing to bring up. There are times where I think euthanasia is in the best interest of the animal, but it's a little weird to suggest that to someone you've never met who is clearly very attached to their pet. In the end, they decided to take the lab home to die; they wanted their time to say goodbye. I helped them carry him out and load him in their truck, not knowing whether he'd make it home alive. I felt very sad for those people.

And if the weekend hadn't been crazy enough, it ended with me having to go out to an employee's house to put one of her dogs to sleep. I've put plenty of large animals down, but never a pet. It was not fun.

Thank goodness Monday finally came and I got to take the dogs to work sheep. Both did a great job! Ella was walking onto her sheep thoughtfully and under control, with really nice feel and showing a good amount of eye. Rae got to do the "fightin' bitin' Rae" exercise, which she really seems to enjoy! We worked on some shedding and then worked on re-lifting tired, stalled-out sheep during fetches. I was very happy with both dogs, and they were very happy to be out of the house after being cooped up while I was stuck at the clinic.

Oh, I have an exciting project in the works...more on this later!

Ella's looking forward to it!