Dr. Jon Geller is an emergency veterinarian and freelance writer in Fort Collins, Colo. His pets include Raindog, a somewhat dysfunctional, but water-loving, lab mix. You can follow all of Dr. Geller's "In the ER" blogs.
News: Guest Posts
In the ER: Veterinarians are sleuths
January 26 2010
Are you sure Dozer did not swallow any dog toys or clothing?” I asked.
“No, we keep the yard cleaned up so there is nothing for the dogs to get into,” Dozer’s owners replied. Thus began the search for the cause of vomiting in an 8-year-old Alaskan Malamute.
There are at least 63 causes of vomiting in dogs, which is probably why we see so many cases at our emergency hospital. If the cause is not apparent after a thorough physical exam and history-taking, sometimes we perform diagnostic tests, such as X-Rays and blood tests to narrowing down the possibilities. A few dogs need an even more sophisticated level of diagnostic workup, such as an adrenal gland function test or abdominal ultrasound.
At eight, it seemed unlikely that “dietary indiscretion” would cause of Dozer’s gastrointestinal problems. Much higher on the list were conditions, such as cancer, immune-system disease, pancreatitis, liver failure or kidney failure.
Dozer seemed uncomfortable and somewhat tense when I palpated his abdomen, but did not appear overtly pained. “Let’s do some radiographs to see what things look like,” I suggested. (My X-Ray vision was not up to par that day.)
When the digital images appeared on the screen, the nurses could tell something was abnormal. We all gathered around to throw our two cents in. Dozer’s intestines were very distended with gas in certain areas. There was a strange density in the cranial (toward the head) part of his abdomen. We kept looking.
In one of my finest moments of X-Ray reading history, I suddenly saw it: “It’s a rubber ducky!” I almost hollered. Squinting at the images and moving closer, we asked each other, “How (and why) does a dog swallow a rubber ducky whole?”
Two hours of surgery later, the naughty duck sat like a proud trophy outside Dozer’s run. It was somewhat blackened after the journey through his intestines, but probably still quite capable of floating, if required. The owners explained, “It used to be Dozer’s favorite toy. He probably buried it months or years ago. He may have been mad at us for leaving him behind for a few days when we went out of town last week, and decided to dig it up and swallow it to get back at us.”
Would a dog do that?
News: Guest Posts
Tales from a Colorado ER
December 23 2009
We used to have sign in our lobby that said “Any unsupervised children will get a cup of espresso and a free puppy.” We took it down after one of the clients asked what kind of puppy. We now have self-serve coffee in the lobby, and it’s not uncommon to see a kid trying to short-circuit the coffee maker.
Which brings us to the case of Tonsi, a seven-year-old, hyperactive Australian Shepherd who tore into the 50-pound sack of coffee beans his mom brought back from Nicaragua. Fortunately, he was discovered before he devoured the entire sack (which certainly would have resulted in his demise), but he did manage to scarf down several pounds.
Our staff has the routine down for toxin-ingestion cases: an injection of apomorphine to cause vomiting (it always works), followed by some charcoal to absorb any toxin from the intestines, then possibly IV fluids for 12 to 24 hours, depending on the ingested substance. To be honest, these indiscriminate dogs seem to keep our ER in business. Tonsi vomited up a large amount of undigested coffee beans soon after getting his apomorphine, but apparently there was a lot more caffeine on board, as we were soon to find out.
Tonsi’s heart continued to race at 180 to 200 beats per minute (normal should be around 80 to 90.) He was amped up and wired to the gills, jumping straight up in superman-like attempts to leap over the eight-foot tall run walls in a single bound. He gave all of us the jitters; it was almost as if Starbucks had spiked our water. I have to admit, equally enthused and irritated by Tonsi, I had been imbibing more than my share of coffee during the shift.
One of our nurses suggested giving Tonsi a beta blocker, which would help slow down his heart, but we did not have any stocked on the shelves. At this opportune time, enter (stage left) Corky, a six-year-old Cockapoo, who had just ingested his owner’s vial of medication, which included (guess what?) a beta blocker.
One more dose of apomorphine, and I found myself sifting through more vomitus. I spotted a small red tablet, perhaps the ingested beta blocker? Tonsi continued to wildly leap in his run, barking crazily. As I slid the red tablet out of the bilious slime with a tongue depressor, an idea crept into my over-caffeinated, somewhat deranged mind: Do I dare?
News: Guest Posts
Tales from a Colorado ER.
November 15 2009
Frank loved to eat things. As a stout one-year-old Lab, eating is what he lived for. Sharing a home with a family that included six-year-old quadruplets supplied him with plenty of objects of his desire. His family reported finding lost clothing, toys and other random items in his stool. Frank avoided any serious issues with his indiscriminate eating habits until one night last month, when he decided to swallow a Beanie Baby unicorn.
After vomiting for 24 hours, and losing his famous appetite, Frank’s owners knew something was wrong. X-rays at our emergency hospital showed a strange bulge in his intestine, with a triangular object encircling it. Large pockets of gas upstream from the blockage confirmed that he had a surgical problem, and off to surgery he went.
Our emergency veterinarians opened up a piece of Frank’s intestines, and found the Beanie Baby unicorn without even a tooth mark on it. Frank must have wolfed it down as if it was a cocktail wiener. Wrapped around the unicorn—perhaps substituting for a piece of bacon—was a rubber band, which is what showed up as a triangle on the X-ray.
Frank had about a foot of his intestines removed, and then the remaining ends were sutured back together. The next day, as Frank recovered from his surgery, we discussed strategies for preventing future recurrences.
“How about a cage muzzle?” I suggested, and the owner agreed it would be a good idea, considering the chaos that usually ruled at his house. With five children running around, the availability of a pair of stray socks, underwear or even another Beanie Baby, was inevitable. The Frankster went home the next day with his owner, the intact Beanie Baby cutely enclosed in a plastic baggie, perhaps destined for display on the fireplace mantle.
We did not expect to see Frank back at our hospital, but one week later he was sick again. He was lethargic and not eating, and one look into his eyes would tell you he was not feeling well. He was clearly, please excuse the expression, “sick as a dog.” Repeat X-rays were suspicious for another blockage, and ultrasound confirmed it the next day. Frank went back to surgery at his regular veterinarian’s clinic, where a large wad of impacted grass and more intestines were removed. Apparently, he had been grazing in the yard, despite the cage muzzle.
Hopefully, we have seen the last of Frank. He doesn’t have much in the way of intestines to spare. Every time dogs undergo repeat surgery, adhesions can form on the surface of their intestines, causing them to stick together. Any previous surgery site can shrink down into a stricture, creating the risk of future blockages. Frank’s family will have to be diligent about keeping his cage muzzle on, and ensure that all he eats is dog food. This should help guarantee that the family’s remaining Beanie Bay collection remains intact. Maybe Frank’s owners could sell it to cover some veterinary bills.
News: Guest Posts
Make My Day: What would you do?
September 23 2009
Many emergency veterinarians enjoy the challenge of gunshot wound cases, especially when we have a good outcome. It’s not very often, however, that a dog comes into our ER in critical condition from a gunshot wound, and survives, and the dog’s owner ends up dead from the very same thing. That is exactly what happened on the afternoon of November 2, 2003.
Mojo was a three-year old Miniature Pinscher, but did not deserve the “land shark” label many MinPins end up with, as he normally was affectionate and friendly. He did like to bark, however, and that tendency would lead to the demise of his owner.
Just before Mojo arrived at our emergency room, his owners, Diane and Richard, found him collapsed in their yard, struggling to breathe. His gums were pale, and he had a wound on the left side of his chest. Oxygen helped him breathe; a quick X-ray showed two bullets in his chest. One bullet was lodged right next to his spine.
As soon as Richard, Mojo’s owner, realized what had happened, he left the emergency clinic and said he was going home. He appeared calm at the time, but his wife noted a look of determination in his eyes she had not seen before. After Richard left, our team of emergency vets and techs continued to work on Mojo, administering IV fluids, pain meds and more oxygen.
When Richard arrived back at his home in the rural town of Ault, Colo., he grabbed a stick of lumber and immediately went next door to confront his neighbor. He knew immediately where the bullet had come from, because his neighbor sometimes complained about Mojo’s barking. The neighbor also ran a jewelry business out of his home, and bragged about the collection of guns he kept for security.
Richard’s neighbor was waiting for him, apparently sitting in a chair in his living room with a shotgun across his lap. When Richard knocked on the door, he shouted at the neighbor to come outside. Threats were yelled back and forth. When the neighbor refused to come outside, Richard broke the small view window in the top of the door. A shotgun blast tore through the open window and hit Richard in the middle of his chest. The wounds proved to be fatal. The shooter was released from county jail nine days later under the Colorado “Make My Day” law, where deadly force can be used to protect one’s self, family and property if they are threatened. The issue of why he could shoot Mojo without penalty was never addressed.
Meanwhile, efforts to save Mojo continued, and proved successful. He was taken off oxygen, moved out of intensive care and started on oral pain meds and antibiotics. Our success in reviving him provided some solace to Diane, Richard’s widow.
Several months later, Diane moved with Mojo to another state to try and put their nightmare behind them. As far as I know, they are getting along OK.
Further investigation revealed that the second bullet in Mojo’s chest was from a previous gunshot, and multiple pellets were also found in the side of the house where Mojo used to roam the yard and bark. He had been used as target practice by the neighbor, whose intolerance of Mojo’s barking proved to test the limits of the law and human civility.
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