Visiting Veterinarian : August rush
August 1, Saturday. My turn on call for the Island Veterinary Emergency Service. I promised myself I wouldn't let summer stress rattle me, so when a client phoned early about a sore on his Jack Russell's back, I was easy. "Not an emergency, but hey, I'm here anyway. Come on down." It looked like an insect bite, maybe tick or spider, easily treated with topical medication. Piece of cake.
A 146-pound Great Dane with hives. My blood pressure rose slightly. Systemic allergic reactions like hives may occasionally progress to anaphylaxis. You know, where the patient goes into shock and dies if not treated immediately? "He looks stable," I reported with relief, checking his vital signs. Benadryl given earlier hadn't helped much. "Intravenous corticosteroids," I advised, "then prednisone at home." Piece of cake.
A busy mom, noticing her pets had fleas, inadvertently mixed up medications and put K-9 Advantix on her cat. Having treated a similar case recently, I was confident about what to do. Abner was twitching violently, but I managed to administer IV muscle relaxants, then bathed him with Dawn dishwashing soap, the best product for these cases. "This should do the trick," I thought. But Abner didn't improve. In fact, he got worse. I called the toxicologist who advised injections of phenobarbital or pentobarbital. Great. I didn't have either on hand.
Now I'm a wee bit stressed. Concerned that his respiratory muscles might fail if the seizures continued, we anesthetized Abner with inhalants while trying to locate the recommended drugs. Two hours and one hospital run later, he was no better. Despite the additional treatment, every time we stopped the gas, Abner was racked with intense tremors. "Wake him up," the toxicologist sighed. "Control his tremors the best you can. If you can keep him alive the next day or two, he'll be fine."
By then the phone was ringing constantly. An anorexic geriatric cat. A limping sheepdog. Nothing too challenging. Abner was twitching badly, but at least he wasn't seizuring. I did some deep breathing. Then, at dinnertime, the call I always dread. "My lab, Franzie, is vomiting and her stomach is bloated." My weary adrenal glands squeezed another adrenalin blast. If Franzie had gastric dilation, her stomach hugely distended with gas, it could be life-threatening. If the stomach twists, that's emergency surgery - or death.
Franzie barreled into the office. No leash. No collar. So excited I could barely examine her. Her stomach looked big, but not tense. "She was swimming earlier," her owner explained. "Then she gulped a huge bowl of water and threw up five times." My heart rate slowed. "It's not bloat," I concluded happily after radiographs and blood tests. "Franzie swallowed too much saltwater while swimming. That made her thirsty, then she drank too much too fast." I sent Franzie off with instructions and gave Abner his evening medications. Still twitching.
Liza, a frail, elderly dachshund was acting uncomfortable. "Maybe an upset tummy?" her mother ventured. "She had a little bluefish earlier." More radiographs. More blood work. There was nothing abnormal except blood-tinged diarrhea, supporting our presumptive diagnosis of gastroenteritis. Sending her off with medications, I stifled a yawn. I was fading.
"My dog is choking!" the caller wailed hysterically. "I gave Ivy a biscuit and it's stuck. Her throat swelled up! She's choking!" Twenty-eight years in practice, I have heard "my dog is choking" countless times. The animal is almost never choking. I determined over the phone Ivy was breathing fine, not coughing. Worse case scenario, the biscuit's stuck in her esophagus, I thought
"Calm down," I commanded, when they arrived. Sure enough, that was a huge swelling on Ivy's neck. Maybe an abscess or infected salivary gland? "How long has this been there?" I asked. "I told you!" the owner screamed. " It just popped up when she had the biscuit!" I tapped the area with a syringe. Nothing. Hhmmmm. To swell up that fast, it had to be . . . what? An allergic reaction? No other symptoms supported that conclusion, and vitals were normal. Trauma? Had something torn inside her throat? Possibly. If so, there was little I could do. She would need a surgical specialist with a fibrotic scope.
I glanced at the clock. Ten pm. Double drat. The last ferry had just left, and Liza's mother was calling again. The dachshund had taken a dramatic turn for the worse. "Ivy looks stable," I said hesitantly, after X-rays failed to provide definitive diagnosis. "I'm not sure what's wrong. You should go see a specialist tomorrow." Unable to assuage this overwrought mother's anxiety, or my own uncertainty, I threw up my hands and added, half-joking, "Or you could charter a boat tonight."
Within the hour, Ivy's owner met Captain Jim from the Patriot Party Boat for a late night run to Falmouth, where a taxi would take them on to the emergency clinic in Bourne. Meanwhile, Liza arrived in severe distress. Her stomach was swollen and painful, her extremities cold, and she was passing thick bloody tissue. Her condition was far more serious than initially thought. New radiographs suggested that something inside had perforated or twisted. After an agonizing discussion, it was clear we were losing Liza. With her age, and other medical issues, she would never survive surgery. The only humane action was to help her on her way. And so, sadly, we did.
After Liza's owners departed, I called Bourne to check on Ivy. The emergency doctor didn't know what was wrong either, but agreed Ivy was stable and tucked her in for the night. (Later that week they would confirm a broken blood vessel in the throat had caused the swelling.) It was after midnight. I dozed off on the couch until 2 am. Time for Abner's medication. I shuffled into the back. Abner wasn't twitching. Not one bit. He was standing up, perfectly content. As I opened the cage, he ran over, purring, and rubbed his cheek against my hand. That's when I started crying. August.