Visiting Vet: Summer visits

It started at 7:30 in the morning. The phone never stopped ringing. Mostly summer people. Seasonal residents with homes. Visitors at Airbnbs. Folks on boats. A few year-rounders. Unlike most mainland communities, there is no 24-hour veterinary emergency hospital on the Vineyard. In summer, the pet population explodes along with the people population. Local veterinarians do their best to triage and treat animals in need. Here’s how a typical day on call began.

Our first patient was a 15-year-old spaniel with recurrent diarrhea. Like many elderly dogs, he had tried multiple pain medications to help with mobility, as his hind end had been giving him trouble. Like many “summer dogs,” he had been traveling. Back and forth between home and here. Even staying with a friend when his owner was away. He had been seen and treated by his off-Island veterinarian, then by a veterinarian here. Just getting a complete history took more than half an hour. His mom also had questions about his overall quality of life. Happily, the old guy looked pretty perky, and once we got through the time-consuming history and conversations, we dispensed antidiarrheal medications, advised bland diet, tweaked his pain medications, dispatched a fecal sample to the lab to rule out intestinal parasites, and sent them on their way.

Next, a female Cavalier King Charles spaniel straining to urinate and passing drops of bloody urine. These cases are tricky. Most people assume their dog has a urinary tract infection and needs antibiotics. They are usually right … but not always. The urology gurus insist the best thing to do in these cases is to always (always, always, always) obtain a sterile urine sample to submit for culture and sensitivity. How does one collect a sterile sample? Roll Charlie Girl onto her back, shave a small area on her belly, prep with surgical scrub, pass a needle through the belly wall into the bladder, suction out urine with a syringe. It’s not as bad as it sounds, but it’s not always easy, especially if the pup in question doesn’t have a full bladder. Occasionally we may just clean Charlie Girl’s private parts, collect urine into a sterile specimen cup as she pees, and send this out for culture, but these samples can still be contaminated by surface bacteria, giving us “false positive” results. 

Why do specialists recommend culturing? If we can prove there is bacterial infection, identify the exact organisms, and determine what antibiotics they are sensitive to, that is ideal. Overuse of antibiotics when not truly needed contributes to the global problem of antibiotic-resistant bacteria. Other differential diagnoses include bladder stones and tumors, requiring x-rays and/or ultrasound for diagnosis. Not every owner wants us to take all these steps for what appears to be a simple urinary tract infection. I understand that, but it still takes time to talk through everything. I sent Charlie Girl off with antibiotics, and went on to the next. 

An old cat on medication for hyperthyroidism, a common endocrine abnormality in kitties. His owner was concerned he had yowled when she picked him up. I couldn’t find an explanation. His temperature was slightly elevated. He had lost weight. She was having trouble medicating him. We had a long conversation about many possibilities, but I sent him home without treatment. (He returned the next day. Now that it was visibly swelling, I found the bite wound on his leg that I had missed previously. Antibiotics, rabies booster, quarantine discussion … next?) 

A routine Lyme vaccine. Then two hyperthyroid cats to recheck. Next a Lab with a big “hot spot” — the quotidian name for acute moist dermatitis, or pyotraumatic dermatitis, a common skin condition in dogs during summer. Usually triggered by itchiness or irritation, the dog then self-traumatizes by scratching, chewing, or rubbing. There is often secondary bacterial infection. We shaved the lesion, since removing wet, matted fur, and letting the area air out and dry is very helpful, and sent her home with antibiotics (both oral and topical) and anti-itch medications. Next?

A dog with a nasty swelling between his toes. Not life-threatening, but uncomfortable. I understand. I’ve taken my kid with an ear infection to the emergency room while on vacation. When your baby hurts, you want to help. This pup had an interdigital follicular cyst, also called follicular pododermatitis or podofurunculosis. These often start with a sort of “ingrown” hair, but can also be from a foreign body, like a bit of burr or a splinter. Secondary bacterial or yeast infections are common. I prescribed antibiotics, yet again. Advised soaking in warm water with Epsom salts, and applying our yucky-tasting ointment to keep him from licking. Next?

A dog stepped on by a horse. That foot is broken for sure. Poor pup. X-rays. Three out of four metacarpals broken. Look at your hand. The bones that go from your wrist to your knuckles are your metacarpals. Imagine you broke three of them, straight across, right in the middle. Ow. I splinted her leg from the foot to just below the elbow. The rule with broken bones is to immobilize the joint above and the joint below the break. The one intact metacarpal would act as an internal splint as well. But I was concerned. With one or two broken metacarpals, a splint is all you need. Four broken metacarpals win you a trip directly to surgery. I wasn’t sure what was best for three out of four. 

Serendipitously, one of my favorite orthopedic surgeons happened to call me to discuss a different patient. I asked about this pup. He suggested he surgically stabilize the two middle metacarpals with internal metal pins. The dog would still need a splint for six to eight weeks, but this would provide better alignment and healing. I contacted the owner and discussed referral. Next? Oh, it’s lunchtime? Do we have time to eat? I’m glad nothing this morning was critically ill or really gravely injured. I wonder what the afternoon has in store.