Visiting Vet: Urgent-care day

What happens when our pets really need their vet?


“There’s a sick Bernese Mountain Dog coming in with a bloody discharge from her vulva,” my assistant told me first thing that morning. My blood pressure went up. In intact female dogs, this can indicate a nasty bacterial uterine infection called pyometra, typically occurring a month or so after a heat cycle. Pyometra can be rapidly life-threatening, requiring emergency surgery. Definitive diagnosis isn’t always easy, especially for old country docs like me without ultrasound equipment. I was envisioning the conversation. Radiographs. Bloodwork. The difficult discussion when I advise traveling off-Island immediately for surgery.

This was my day covering “urgent care.” Bernice, the Bernese, was not my regular client. I didn’t know her or her owners. I glanced at the record. Phew! She was spayed. So not pyometra. Except there’s another condition called stump pyometra. This can occur if remnants of the uterus or ovaries have been left behind, either by mistake during a spay, or intentionally when owners choose to have only the pet’s uterus removed, rather than the traditional ovariohysterectomy, which removes everything. The symptoms can be the same as uterine pyometra. Treatment is still surgical, removing the infected stump and any remaining ovarian tissue, since it is the hormone production that creates the problem.

When our big, shaggy patient arrived, I shaved her hind end and was able to see the bleeding was not coming from her urogenital tract at all. Bernice had a nasty, oozing skin infection across her rear end and inner thighs. It was easy to see how her owner might have mistaken the anatomy, between the swelling and the furriness. We cleaned her up and sent her home with antibiotics and medicated wipes … just in time to see Bart, the middle-aged golden retriever.

This sweet dog had an episode that morning of stumbling on the stairs, then collapsing for a few minutes. By the time he arrived at my office, he looked completely normal. His gums were pink. He was happy and alert, and ate my liver treats eagerly. Now, whenever a middle-aged golden retriever collapses, the first thing every veterinarian thinks is hemangiosarcoma, a form of cancer typically affecting either the spleen or the heart that causes internal bleeding. Bart’s owner was only too aware of this disease, having lost several previous pets to it. But Bart didn’t look like a dog who was bleeding internally. They usually have pale gums, and are often panting, with elevated heart rates. Bart’s heart rate was normal, but as I listened, I occasionally heard an irregular rhythm. Goldens are prone to several types of cardiac disease that can result in syncope (in other words, fainting.)

I went over him again, nose to tail. We got copies of recent abdominal radiographs from his regular vet, and took chest films here. No sign of any tumors. We ran bloodwork and sent additional tests to the reference lab. The differential diagnosis included cardiac or neurological disease leading to syncope, primary musculoskeletal issue such as back pain, and to rule out hemangiosarcoma. I sent Bart home with instructions to observe closely, and consider going to Cape Cod Veterinary Specialists for an ultrasound and consultation with a cardiologist and neurologist.

Betty, the next old dog, most likely has a benign balance disorder called geriatric canine vestibular syndrome, causing dizziness, head tilt, and circling. Unless it was a brain tumor, stroke, or middle ear infection. But odds were on vestibular syndrome that would resolve spontaneously over the next few weeks. I sent Betty and her owner on their way with nursing care instructions … just in time to see Sally, the Havanese. The initial phone call was that Sally was panting and lethargic, but the moment she arrived, I knew Sally was actually dyspneic. That means she was having serious trouble breathing, her chest and abdomen heaving with every inhale. I could auscult a significant heart murmur and “rales,” suggesting the presence of fluid in her lungs. Radiographs confirmed an enlarged heart and pulmonary changes consistent with congestive heart failure, though I could not rule out other lung diseases, including cancer. I advised that the best thing for Sally would be to go immediately off-Island to a large referral center to be hospitalized in an ICU oxygen cage, monitored closely, and have further diagnostics and aggressive inpatient treatment. While they considered their options, I sent Sally home on diuretics to try to relieve the pulmonary edema, just in time to see …

Huck, the Pomeranian cross, with a whopping fever. Probably a routine case of tick-borne disease — Rocky Mountain spotted fever, anaplasmosis, or Lyme — except the symptoms began the day after Huck came home with a bloody rabbit carcass in his mouth. He had been covered in bunny blood, and exposed the owners while they cleaned him up. Islanders will know my concern. Did you say tularemia? Correct! A bacterial infection often carried by rabbits, I see a case or two every year in cats, but tularemia infection in dogs is extremely rare. However, because of the human exposure, we felt a tularemia test was necessary. This involves special sample handling and shipping directly to the USDA lab in Iowa. We started Huck on two antibiotics to cover both tularemia and tick-borne illnesses.

Just a few of my cases on my urgent-care day, none of them my regular clients. Sometimes I get follow-up and learn the outcomes. Sometimes not. Bernice the Berner healed up fine. Huck did not have tularemia, leaving a presumptive diagnosis of Rocky Mountain spotted fever, which responded well to treatment. I never heard back about Betty or Sally. Sadly, Bart was ultimately diagnosed with a small but deadly bleeding splenic tumor. Having a definitive answer helped his owners know it was time to let him go. My heart goes out to them, as it does to each and every owner and pet seeking urgent veterinary care. Thank you for understanding our limitations on the Vineyard, and for always trying to do what is best for your best friends.