Visiting Veterinarian : Seven dwarves
By Michelle Gerhard Jasny V.M.D.
Published: July 31, 2008
Hi ho, hi ho! It's off to work we go. The first phone call of the morning was about an injured hummingbird. Now, I love hummingbirds with their magical, fluttering wings and nectar-sipping wiles, but I don't know anything about them. Really. What I did know was that I was swamped with work and did not have the proper facilities, nor the time to research how to triage and treat a hummingbird. Besides, we already had a baby robin with head trauma we were hand-feeding hourly. "The best thing you can do is take the hummingbird to the Cape wildlife center," I advised. "They are fully funded and equipped, and have experienced staff who know much more than I do about such things."
The hummingbird lady was not thrilled with my suggestion, but my next patient, 90 pounds of annoyed male mastiff named Happy, awaited me in the exam room. Happy didn't like me. Go figure. Maybe it's because I was about to neuter him. I had planned ahead, asking his owner to hold Happy while we administered the anesthesia. "Got his head?" I asked the mastiff's owner as I edged into the room. "Uh huh." "Are you sure?" I replied, warily sidling up to the table, thinking I'd rather be treating a hummingbird. He nodded. I poked the needle into the dog's massive haunch. Five minutes later he was sleeping like a baby. Surgery was quick, and Dad returned for the recovery, taking Happy home as soon as he could wobble out the door. Usually we keep surgical patients until they are wide-awake, but we opted to move Happy out while he was still Sleepy, before he could express his opinion of me too strongly.
Next was a dental procedure under anesthesia for an elderly greyhound, Bashful. A routine event, except, as we say, there's no such thing as routine anesthesia. Greyhounds are notorious for having unusual reactions, but I wasn't too worried. Bashful had been given the same anesthetic before without a hitch. Once Bashful was Dopey, my assistant cleaned and polished her teeth. All went smoothly until shortly after she woke up. Bashful suddenly began panting and trembling violently and her temperature rose rapidly from a normal 102 to a life-threatening 108.
Malignant hyperthermia (MH) is defined as a "rapid, exaggerated, uncontrollable elevation of body temperature, in animals susceptible to the syndrome, induced by external stimuli." Symptoms include high fever, panting, muscle spasms, cardiac arrhythmias, kidney failure, disseminated intravascular coagulation, and death. Most veterinary cases have been connected to the inhalant anesthetic halothane (which we do not use), but other drugs and environmental factors, including plain ol' stress, are sometimes implicated. MH has been documented in dogs, cats, horses, pigs, and people, and made national news in March when a Florida teenager died from MH during reconstructive breast surgery. Similar less lethal maladies include "canine stress syndrome" and "exercise-induced collapse." Although more research is needed, it appears that all these syndromes are caused by genetic abnormalities. Dogs with true MH often die unless given a specific muscle relaxant that few veterinarians have on hand. So when Bashful's fever spiked suddenly, so did my adrenaline levels.
"Get her on the tub table! Let's go!" I placed an intravenous catheter, started fluids and medications, and began rinsing her with cool water. Her temperature came down one degree to 107. Better, but still scary. I called her owners and explained the situation. More cool water baths, more fluids. 106...104. As Bashful stabilized, so did my heart rate. This appeared to be canine stress syndrome, not true malignant hyperthermia. In the meantime, afternoon appointments rolled in. Leaving an assistant with Bashful, I saw the hypothyroid Golden with severe allergic skin problems, the sneezing, coughing cat, and the cat with liver cancer. Once Bashful's temperature was normal, her mom came to get her, but then Bashful started trembling and panting again, and her temperature climbed back to 103. "She's just too stressed here. You should still take her home," I ventured uncertainly, not wanting to release a sick dog but believing that anxiety from being hospitalized was the root of her problem. "Crank up the car AC and call me when you get home."
I shifted emotional gears for my next visit, the euthanasia of a very sick little dog who had been my friend for fifteen years. As I came somberly out of the exam room a while later, my secretary held out the phone. "Bashful's temperature is up to 106!" Grabbing the receiver, I could hear her gasping harshly in the background. "Hose her down right now with cool water!" I said. "I would have you bring her back immediately but I'm afraid she might die in the car." Her owners calmly got her under the hose with a promise to call back soon. I sat down, emotionally drained, and waited by the phone. Bashful responded to home treatment. Her temperature came down and stayed down. I saw more appointments.
On the schedule was a gentleman who had called last month to say he would be vacationing here briefly in July. His dog needed a weekly arthritis injection prescribed by his regular veterinarian. Could I do it? My secretary had informed him we were not taking new clients. Knowing the injection would take two minutes to administer, in a moment of weakness, I said we would accommodate him. Now here he was. Ten minutes late. With two huge Newfoundlands. "I don't need the shot today," he began. "But this dog has a whole lot of other problems I need checked."
"We did explain we're not taking new clients," I sighed, watching my next appointment pull into the parking lot. "I can refer you to the veterinarian on emergency call...or tell you who's taking new clients." The man began to argue with me. Ah, he must be Grumpy. Very soon three children would arrive at my house, requiring me to put on my Mommy hat. I again offered to refer him, politely suggesting he should have called ahead if he needed anything beyond the simple injection we had agreed to do. He stormed out, tossing back a sarcastic comment, thanking me for how much I cared about animals. Hi ho! Hi ho! The perfect end to Doc's day. At least Happy and Bashful were both safe and sound at home. I wonder how the hummingbird made out.
