Christmas on call
When we invited friends over Christmas Eve, I warned them I was on call. "It shouldn't interfere with dinner," I said. "December 24th and 25th are the quietest days of the year." After a moment's consideration, I added, "Except when someone does call, it's usually a real emergency."
Our guests arrived simultaneously with Baby, a four-month-old Maltese-Bichon cross. A tiny ball of white fluff, she had taken a longish walk on the beach with her family. When she tired, they tucked her in the car while they continued enjoying the Vineyard. By the time they returned home, Baby was trembling all over and so weak she could barely walk. I began my exam by taking her temperature, which registered just below 99 F, normal being 101-102.5 F. "She has a touch of hypothermia," I explained. "It's too cold for a little thing like her to sit in the car for long. Let's warm her up."
As I returned with hot water bottles, Baby suddenly stretched her neck back in a peculiar way, then let her head droop limply. "Looks like more than a chill," I thought silently, not wanting to alarm her owners. Weird neurological disorders flitted through my mind. Could it be Maltese encephalitis, that odd genetic disorder that was both untreatable and fatal? What about White Shaker Syndrome? Not fully understood, this disease manifests in little white dogs as whole body tremors, and is treated with corticosteroids.
Wrapping Baby in a towel with the hot water bottles, I thought of the veterinary adage "If you hear hoofbeats, don't look for zebras." Maltese encephalitis and White Shaker Syndrome were zebras. There was a far more likely explanation for Baby's symptoms. "When did she eat last?" I asked. Aha. Baby had refused lunch. In fact, she had not eaten since breakfast. I pulled out my handy-dandy glucometer and, after a bit of high-pitched protest from my patient, obtained a drop of blood. "She has hypoglycemia as well as hypothermia," I concluded. "Her blood sugar is so low she is on the verge of having a seizure." I offered a variety of foods, but Baby would not eat. "Where is that Karo syrup?" I mumbled, ransacking the office cabinets. Unable to locate where my staff had stowed it, I ran into my kitchen and grabbed the honey, mystifying our guests who were there munching appetizers. I force fed Baby honey, then Karo syrup that I eventually unearthed. Ten minutes later, her body temperature and her blood sugar were on their way back to normal. "Keep her warm. Feed her every few hours. And buy her a sweater." I escorted them to the door. I was feeling a bit hypoglycemic myself and my friends had held dinner for me.
The rest of the evening was blessedly uneventful. The next morning, however, the telephone rang early. Mrs. Claws, the cat, was hiding, refusing to eat, and generally acting strange, making a dramatic gagging, retching noise and acting painful in her belly. Claws was an indoor kitty, but yesterday a friend had left a beautiful arrangement of greenery and berries on their table. Claws liked to chew unusual things. Although they couldn't see clear evidence that she had eaten the centerpiece, they couldn't rule it out.
"So what's in the bouquet?" I asked, listing the common poisonous plants we expect this time of year. "Any lilies? Mistletoe? Holly?" "The only thing I recognize is eucalyptus," her owner replied. "Bring me both Claws and the bouquet and we'll see what we can figure out." The diagnosis was complicated by the fact that Claws had recently been exposed to kittens with an upper respiratory virus. Had she eaten something toxic, or was she just coming down with a cold? Examining the array of foliage the clients presented me, I knew I was out of my botanical league. It was time to call Poison Control.
"I know this is a long shot," I greeted the toxicologist, "but can you help me identify these plants over the phone?" I described the plants one after another, starting with the berries. "No, it's not any kind of holly," we agreed. "How about partridge berry?" she suggested. "Let me Google for photos," I replied. We Googled plant after plant so together we could look at the same pictures as we talked. We learned that along with the readily identified female eucalyptus, the other foliage was male eucalyptus. We couldn't pin down the red berries, but decided we had ruled out the common toxic ones. If Claws had gnawed on any of these plants, it was unlikely to cause anything more than an upset stomach, which we could treat with simple supportive and symptomatic care.
While I was still playing botanist with Poison Control, my husband handed me a note. Ah, the obligatory chocolate ingestion. It wouldn't be Christmas without one. This big dog had eaten enough semi-sweet chocolate to cause concern. I had finished up with Mrs. Claws and dealt with the chocolate-chowing dog (whose owners had successfully induced vomiting at home), when the next call came. What happened to my quiet Christmas shift? What now? You're kidding...a 13-year-old obese, diabetic Shar Pei? This owner had quite a dilemma. His dog, Prancer, had been unable to get up today and was refusing food. He was an older gentleman and couldn't get this heavy, immobilized dog in the car, yet he was afraid she might not make it through the day without veterinary attention.
Now, for many reasons, I usually don't make house calls during emergency hours. "Do you have a friend or neighbor who could help get her here?" I asked hopefully. He did not. I called the Sheriff's department. Was there was an Animal Control Officer on call in the gentleman's town today? "Only a police officer for emergencies," the dispatcher replied. "Ah, heck," I thought "I'm not gonna make some cop miss Christmas dinner." I packed my house call bags and headed off. My handy-dandy glucometer once again helped make the diagnosis, along with a urine sample fortuitously supplied by my patient soon after my arrival. Prancer was indeed on the verge of a crisis. Unlike Baby, whose blood sugar had been too low, Prancer's was sky high. Recently diagnosed with diabetes, the decision had been made to delay starting insulin until after the holiday. In most cases, this is not a problem, but Prancer was developing a serious metabolic imbalance called diabetic ketoacidosis. The ideal treatment would be to hospitalize Prancer, but her owner wanted to try home care first. Encouraged by the fact that she finally managed to get up and walk, and then ate turkey from her owners hand, we decided to start her carefully on insulin and hope that was enough to get her through until her regular veterinarian returned.
I arrived home just in time to see a case of Little Dog shaken by Big Dog. Radiographs did not show any break or dislocation and Little Dog could move all his legs, but he was unable to stand and seemed dazed. "There's been some spinal cord trauma," I told his owners, "but I think it may resolve with medical treatment and time." Short of referring them to a neurologist off-Island, all I could do was treat him, hope for the best, and send him back to his regular vet in the morning. The rest of the night was peaceful. The following day my family headed for Florida vacation. I'm writing this by the pool listening to the waves, wondering how everyone is doing back home. I called to check in on Little Dog. His regular vet says he's doing fine. I'm glad. I'm also glad I'm not on duty New Year's Eve.