It was Thursday. My day on call covering urgent veterinary care for the whole Island. Eight in the morning, the phone wouldn’t stop ringing. One of my staff was out of town. The second called out with a sick kid at the last minute. The third simply hadn’t shown up. The phone rang again. I can do this, I thought, as I booked emergency appointments one after another. By 8:30 am I had reached the missing staff member. She had misunderstood the work schedule but would come to help as soon as possible. Until then, owners would have to assist me, like in the old days before I had “staff.” We can do this, I thought.
My first patient you might remember from an earlier article — Bonito, the Labrador retriever with meningoencephalitis. He had experienced a bad reaction to one of the immunosuppressive drugs prescribed by the neurologist, leading to serious ulcerations on his lips, gums, and nose, but once we realized it was a medication side effect and switched to a different protocol, he was doing well. Today all we needed to do was draw a blood sample and run one test to check his medications weren’t affecting his bone marrow. Bonito is an easy-going guy, but his owner doesn’t like needles. I get it. I have a daughter who hates needles. My other kid is arachnophobic. I’m afraid to fly. We all have our quirks. But Bonito’s dad was a trouper. “I’ll just look away,” he said while he held his dog steady for me. We can do this!
My next patient, Thor, presented for vomiting and copious bloody diarrhea. Weighing in at almost 100 pounds, he was naturally more high-strung than Bonito, but his owner was skillful. She gave me a detailed history of many previous bouts of gastroenteritis, simultaneously holding Thor while I did my exam and administered injectable anti-nausea drugs for the vomiting and antibiotics that had proven helpful in the past. I sent them off with antidiarrheal medication and prescription food. Now, in between all this, I had been answering phones, scheduling urgent care visits, deflecting calls that were not emergencies. What I was not doing was checking my email, so it wasn’t until much later in the morning when I saw the correspondence about Zuz, a senior cat who might have eaten part of a rubber band.
Linear foreign bodies. Who knows why some cats like to eat rubber bands, string, ribbons, hair ties, tinsel, and the like … but they do. In many cases, the object in question manages to wind its way through all the twists and turns of the small intestines, then the large intestines, and finally come out the other end. But sometimes one end of that linear object gets stuck, while the gut continues to push the rest of it downstream. Think of it like a drawstring in your sweatpants. If you hold one end while you tug on the other, the material bunches up around the taut string like an accordion. This is called plication and it is what can happen to the intestines when a linear foreign body gets stuck. Left untreated, this creates a life-threatening obstruction. That tightly stretched strand can also become like a weed-whacker string and cut right through the gut.
Zuz had a history of swallowing rubber bands in the past, so although we didn’t know for sure she had eaten this particular one, odds seemed high she had. The owners wanted me to induce vomiting. I understood, but there were a few problems with that plan. We had no idea what time Zuz may have eaten it. They had found a remnant on the floor at 6 am. By the time they got to my office it was six hours post-ingestion, maybe more. The rubber band might have passed out of the stomach into the intestines, in which case vomiting wouldn’t expel it. Second — it’s really hard to get cats to vomit. Dogs barf easily. Not cats (except when you don’t want them to). Third — the only drug I have on hand to make cats vomit has potential cardiac side effects, and Zuz has previously diagnosed significant heart disease. Did the potential risks of trying to induce vomiting outweigh the possible benefits?
“Can you X-ray her to look for the rubber band?” the owners asked. My initial reaction was that it would not show up on a film. Hair ties, yes. They often have a metallic component in the fiber. Rubber balls, yes. That perfectly round bubble of air inside is very distinct. But not plain old rubber bands. The owner then showed me an article indicating that, in fact, plain old rubber bands often are visible on X-rays, albeit faintly. Okay. Learn something new, even after 40 years. I can do this. One hour and multiple X-rays later I couldn’t figure out what was wrong with my system. Being a senior solo country doc, I can’t afford to upgrade to digital radiography. I still develop old-school films with chemicals. I changed the developer. I changed the exposure settings. Nothing resulted in an adequate image to diagnose if there was a rubber band somewhere in Zuz’s belly, and I didn’t have time for more troubleshooting. So now what?
We discussed options. Zuz was a big cat and seemed perfectly fine. It was a fairly short piece of rubber band. “There’s a good chance she can pass it in her stool,” I said. “You could monitor her, and feed fiber-rich foods and lubricant laxatives to help move it along.” The owners eventually decided to take Zuz to Angell Animal Medical Center in Boston, where she stayed for several days. They did lots of tests and various supportive care but no major interventions for the rubber band — which, I am happy to report, in the end, came out the other end. I, too, came out the other end of my crazy busy day on call. Labor Day can’t come soon enough. We can do this.
You’re our hero! 😻
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