Visiting Veterinarian : Not on the menu
Bellie, a black standard poodle puppy, seemed to have a sensitive stomach right from the start. Her intermittent bouts of diarrhea would improve with bland diet and Pepto-Bismol, but they recurred frequently. We tested for intestinal worms and other parasites.
We tested for Giardia, that pesky, ubiquitous protozoan that defines the adage, "Be careful what you look for. You might find it." Perfectly healthy pets may test positive for Giardia, but specialists generally do not advise treatment unless there are visible symptoms. Well, Bellie had symptoms, so when she tested Giardia-positive, we prescribed metronidazole. Her poops improved temporarily. Then she got the runs yet again. This time we tried a special intestinal diet and a second Giardia treatment, different medication. This seemed to do the trick.
With this history of upset tummy issues, I wasn't too concerned when Bellie had a bout of vomiting last week. "Withhold food today and give Pepto-Bismol," I advised, rattling off my non-specific gastroenteritis spiel. "Small multiple meals. Nothing too fatty or spicy. Wean back to regular diet slowly." Bellie's parents were willing, but worried. "I'll see her tomorrow if she doesn't improve," I assured them.
The next day Bellie was decidedly not better. "She's vomited twice more," her mother reported, "and refused breakfast, a highly unusual event." She regaled me with details. "She's been burping a lot for the last week or two, especially at night...she's urinating more frequently...she spit up white foam two nights in a row."
I examined Bellie. Normal temperature. No abdominal pain. Color good. Everything looked okay, but something just didn't feel right. "Has she had anything unusual to eat recently?" I asked. No, but Bellie had the typical puppy tendency to chew. "She shredded my socks last week," mom replied, "and chews up her toys." My heart sank a bit as we began diagnostic tests.
"Blood work is normal," I informed her mother later, "but the X-rays are worrisome. I don't see an actual foreign body, but cloth and plastic items like socks and toys won't show up on plain films." Loops of bowel slightly dilated with gas made me suspicious of a possible obstruction. The ideal next step would be a barium series - force-feeding radiopaque liquid, then taking repeated films for the next 8 to 12 hours to define any foreign bodies or obstruction. The problem? It was Friday afternoon. Soon my assistant would go home, and my children would expect my attention. If we started a barium series now, I might be taking X-rays all by my lonesome until midnight. And then what? If she needed surgery, the best option on a weekend would be referral to a mainland emergency clinic with full staff, specialists, and 24-hour intensive care. But then again, I didn't know for sure she needed surgery. I simply had a gut feeling there was something in Bellie's gut.
"I think she's looking better," her mom equivocated with a torrent of wishful thinking. "The sock-chewing happened over a week ago. I doubt she's eaten any toys in the last few days." Ah, but a sock eaten last week might cause only mild signs at first, while in the stomach. Once it passed into the narrower intestines, then is could get stuck, making the dog sicker.
What to do? A late night barium series? Was I overreacting? Empirical treatment for non-specific gastroenteritis? Immediate referral? Plain old wait-and-see?
Then the proverbial light bulb went off over my head. I could give her barium-impregnated polyethylene spheres (BIPS). I hadn't used these in years, but I had some on the shelf. I gently made Bellie swallow a big capsule containing 40 little barium spheres. Her stomach juices would dissolve the gelatin capsule, releasing the BIPS. We could take another film first thing Saturday morning. If the BIPS had moved through her system, we could rule out obstruction.
I tossed and turned all night. Was it a good decision to wait? Would things be better or worse in the morning? Would I be letting my clients down if I referred them off-Island? Or would that be the right thing, making sure Bellie had the optimum care available? I was slated to be on weekend call for the other Island veterinarians. If needed, could I do the surgery and aftercare while still covering emergency duty?
Bellie waltzed in the next morning. "Any more vomiting?" I asked anxiously. "Have I got a story for you!" her mom replied. Bellie had been very depressed all night but this morning they had gone for a walk. "She had this long, weird bowel movement and started feeling better immediately after that!" mom said gleefully. "I've got it in the car. Want to see?"
Did I want to see? Absolutely! She brought me the stinky plastic bag. Holding my nose, I pulled out nine inches of dense, tubular feces, and began dissecting the logs. "Here's your sock," I said after a minute. " And what's this? Ah, a rope chew toy!"
Bellie did look better. Much better. Begging for food, wagging her tail. We took the scheduled X-ray and much to my surprise, the BIPS were still in her stomach. They should definitely have moved by now. "Maybe her gut motility shut down from the obstruction and will start moving again now that she's passed this stuff," I said hopefully. "Then again, maybe there's more socks in there." I knew one thing for certain. We wouldn't jump into surgery on a pup looking this healthy. Bellie ate baby food eagerly.
I sent her home with feeding instructions and medication to lubricate any remaining foreign material and help it pass. The next day, BIPS started appearing, well, you know where. Bellie's belly was all better. By Monday radiographs were normal. Her family has disposed of all chewable dog toys, bedding, and the like, and promises to be vigilant about securely stowing all socks in the sock drawers.
I love happy endings.
