Visiting Vet: On call

We have to be ready for anything.

A sick pet can be on the mend if an illness is treated promptly. —Ruby Schmank

I wasn’t too concerned about being short-staffed, even though it was my turn on call for “urgent care.” A small group of veterinary practices here rotate providing basic emergency services the best we can. It’s always challenging, so even in the winter I don’t book routine appointments those days. Now I was down to one assistant. Just Fawn and me for all the Island cats and dogs. It’s January, I thought. Traditionally one of the sleepiest times on the Vineyard. How busy can it be, right?

Our first patient was Hope, a young cat who was lethargic and not eating. As a kitten, Hope had been diagnosed as a carrier of feline leukemia virus (FeLV), but has been without symptoms and doing well for three years. The only abnormal finding was a fever. We call this an FUO: fever of unknown origin. (I like to call them UFOs, but no one thinks that’s funny except me.) FUOs are often caused by upper respiratory viruses or other minor infections that pass with supportive care, but fever can also be a symptom of FeLV. To complicate matters, Hope had a similar episode last year, at which time she had tested positive for antibodies to Lyme and anaplasma, and responded to treatment with doxycycline. We repeated that test this year. Positive again for antibodies to these tick-borne diseases.

A dilemma. Were those just residue antibodies indicating exposure, but not current infection? Did she really have tick-borne disease? Or some other random minor infection that would pass? Or was her FeLV finally causing clinical illness? Treatment and prognosis for each possibility was different. Making a definitive diagnosis would be difficult. We ran a few additional tests, gave medication to reduce her fever, and doxycycline again. Time will tell how she responds.

Next appointment was to check a lump on Melo, an adult golden retriever. Usually “check lump” appointments are simple. Some are readily identifiable. Abscesses. Seromas. Benign fatty growths called lipomas. Other times we take aspirates, and send slides to a pathologist to evaluate for cancer. But Melo’s lump was unusual — a very large, rapidly growing mass on the back of one leg. Considering that golden retrievers have a very high incidence of cancer, I immediately advised sending out an aspirate. Tapping the growth was also not so routine. Not surprisingly, there was some bleeding, which I was concerned would affect the pathologist’s ability to make a diagnosis, but I sent the slides to the lab with my fingers crossed and sent Melo home to await results.

In the meantime, a dog hit by a car was brought in. I’m an old doc with limited funds, so I don’t have digital radiology. I still use film, and have to warm up my chemical processor to take x-rays. Reynard, a young Australian shepherd, was in stable condition, but three-legged lame, with pain on palpation of one spot on one foreleg. Our first x-ray did not come out clearly, but enough to confirm where the problem was. Luckily, Reynard was an excellent patient, and let Fawn take additional films by herself. These films showed transverse nondisplaced midshaft fractures of both radius and ulna.

So now there was a new issue. Reynard was going to need six to eight weeks of rechecks, and these folks no longer had a regular Island vet. Follow-up care for such cases is another complication of the veterinary shortage. I could apply a splint today, but just cannot take on new patients for ongoing treatment. We discussed their options, and got them connected with veterinarians on the Cape. Reynard went home with instructions about splint care, pain medication, and mild sedatives to keep him mellow as he heals.

The next dog, Pal, was an adult terrier who had been shaking all night. His temperature was way below normal, pupils constricted, heart rate abnormally slow, and he was twitching all over. This looked like some type of toxicity. Pal was in big trouble. He needed to be hospitalized at Cape Cod Veterinary Specialists in intensive care. While getting everything arranged, we tucked him in with hot water bottles, placed an intravenous catheter, started fluids, and began blood work. But before the next ferry, we had test results. Stage 4 kidney failure. I called the specialist and discussed the case. Prognosis was grim. It was extremely unlikely they could save him. What could have caused this? Pal led a sheltered life with no known exposure to any toxins. We will never know for sure. We just knew we needed to let Pal go, and lay him to rest peacefully here on the Island.

Next came Amado, a Newfoundland with weight loss and other vague signs. We started our workup one test at a time. But with each test, the differential diagnosis became more difficult and more worrisome. Amado had significant kidney disease, but the cause and potential severity were unknown. The biggest concerns were leptospirosis or Lyme nephritis. Leptospirosis is a serious infection caused by several subtypes of spirochete bacteria. It is spread primarily by contact with contaminated urine, water, and/or soil. We don’t see it here often, and Amado had not traveled off-Island recently.

Lyme nephritis seemed more likely. A rare but often fatal complication of Lyme disease, it affects less than 1 to 2 percent of Lyme-infected dogs, but results in acute, progressive kidney failure. I have only seen a handful of cases in 40 years. All died within a week. I prescribed doxycycline, which can treat both lepto and Lyme infection, but not Lyme nephritis, and gave a poor prognosis. Amado later went to the specialists, who concurred with the diagnosis of Lyme nephritis, and essentially prescribed hospice care.

At five o’clock I gave Fawn a little bonus for all her hard work and sent her home, both of us hoping we would not be called back for any nighttime emergencies. It had been a hard day for us, but even harder for the families of these beloved pets.