Visiting Vet: On call

Pay it forward, pay it back.

A young Siberian cat feeling healthy enough to explore outside. — Pixabay

Early Saturday morning, an email arrived from another veterinarian who is part of the cooperative system we have for rotating emergency coverage. Dr. One was almost finished with a 24-hour shift on call. One of my clients had just called about Mischa, a middle-aged neutered male cat. Mischa’s owner reported the cat’s appetite was off, his belly distended, and he was having difficulty walking. Dr. One’s shift was ending, mine about to begin. Could I take the case?

The week before I had gotten an early morning call at the end of MY 24-hour shift. A very large dog had fallen from a second-story window. I FaceTimed with the owners, and assessed remotely that the dog was fairly stable, though clearly traumatized and unable to get up. Likely a broken hind leg. Possibly broken pelvis. My dilemma? My X-ray machine is in the basement. By the time I could arrange enough help to carry this very (very) large dog downstairs on a stretcher, my shift would be over. The dog almost certainly would need hospitalization and possibly major surgery, which I could not provide in any case. The owners were amenable to waiting a while if they could then go directly to a larger hospital. I called Dr. Two, the veterinarian from the larger facility, whose shift would start in an hour. Dr. Two agreed to take the case. Thanks!

So, yes. Pay it forward, pay it back. I told Dr. One to send Mischa my way. My first concern was ruling out a urinary tract blockage. Feline Lower Urinary Tract Disease (FLUTD) includes several different conditions affecting urination in cats. The most common are feline interstitial cystitis, an idiopathic inflammatory condition of the bladder, and bacterial urinary tract infection. In neutered male cats, the urethra, which carries urine from the bladder out through the penis, can be unusually narrow. Debris from inflammation from FLUTD can block the urethra, obstructing urine outflow. This becomes life-threatening very quickly. Affected cats may strain repeatedly to urinate and lick their genitals. As the bladder becomes severely distended, they may walk slowly and gingerly, as it is very painful. Was Mischa blocked?

Exam and radiographs soon determined that Mischa did not have a urethral blockage. Mischa was full of … constipation. By this time the deluge of panicked phone calls from (mostly) summer people with veterinary emergencies had begun rolling in, and my assistant had arrived. We gave Mischa subcutaneous fluids to hydrate him, oral laxatives, and an enema, and tucked him in with a litter box in a cage.

Here’s the next twelve hours. A young, beautiful Siberian cat with a propensity for eating plastic came in for vomiting and raspy breathing. A family called about a dog who had ingested chewing tobacco. After multiple phone calls, including referral to Animal Poison Control, it turns out the dog had just stepped in something outside that looked like chewing tobacco, but the owners didn’t really know what it was, and the dog didn’t really eat it but did lick her paws after stepping in it, and then was vomiting, but now seemed better so they declined an appointment. (I understand their concern, but that’s an hour of my life I won’t get back!) A Norwich terrier with sudden onset of fever and limp, but negative test for Lyme disease. A Yorkie with a corneal ulcer, i.e., a scratched eye. A big, goofy golden retriever puppy who had liquid diarrhea for four days. An emotional support rabbit with a neurologic or balance disorder. A schnauzer mix with a long, complicated history of kidney and adrenal gland disease, Lyme, and hypertension, who had been coughing, panting, and vomiting. An elderly Great Pyrenees with a badly infected foot. A labradoodle puppy who ate his owner’s edibles stash. (There’s a reason they call them “edible.”) A Labrador suddenly drooling prolifically. A French bulldog with an extremely itchy swelling on his head, maybe a spider bite. Another French bulldog with a history of previous urinary tract infections, with blood in her urine again. A hound dog with vomiting and diarrhea. A dog with a hot spot. A cat with a swollen lip.

We dealt with these cases. One by one. Some by phone. Some by “no contact, curbside” drop-off. My assistant and I were wearing masks and face shields, disinfecting everything, including ourselves, between patients. We celebrated when Mischa passed four small balls, but there was more still in there. At lunchtime, we gave another enema. (Being a veterinarian is such a romantic profession!) By end of day, he had passed enough to go home, with instructions about how to avoid a recurrence. Sometimes severe constipation is a one-time episode. Sometimes it is indicative of a condition called megacolon, in which part of the bowel loses its oomph, and has difficulty contracting properly to expel feces. The colon becomes enlarged. Waste accumulates in clumps too large to pass. This is called obstipation, and often requires general anesthesia and manual removal of the stool. (Think latex gloves and lots of lubricant. See? A romantic profession.)

Things quieted down by evening. I went to bed hopeful of a good night’s sleep. Sadly, I had a 3:30 am call about a sweet old dog in distress. I was glad to help this family let their beloved pet go gently, no matter what time it was. Back to sleep by 5 am, only to be awakened again an hour later. A dog who had been limping since yesterday. “It’s 6 in the morning … on Sunday,” I said, yawning loudly. The owner replied his regular vet wasn’t open, he always gets up early himself, and he was concerned his dog might have Lyme. “It’s 6 in the morning,” I yawned again. “And this isn’t urgent.” I suggested he call back at a more reasonable hour to Dr. Three, whose shift would start at 8 am … and I went back to sleep. Pay it forward, pay it back. Thanks, Dr. Three!