Long day in the animal clinic emergency room

Published 6:45 pm Friday, October 2, 2020

I got caught by a stoplight so I was parking as my shift began Sunday morning. I was in the building by 8:02 a.m.

The doctor I was relieving seemed happy to see me. She quickly went through the cases.

She had done two enterotomies (for a gunshot and an eaten towel), had five cages of parvovirus puppies or panleukopenia kittens, two pancreatis dogs, a few other cases and very little sleep. A cat whose spay sutures were missing was on the table ready for surgery.

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I quickly mentally categorized the patients into what I would need to do for them and offered to take over the spay repair.

All of the packs had been used during the night, so I used what we call a micro or laceration pack.

Luckily, I had brought some of the gloves I like, because they had run out of my size. I left what I brought to be shared with the other doctors who had the same size hands. Little did I know they would be gone before I would leave.

Because of COVID-19, ER communications can be difficult. Not only are we curbside, but often there is not enough time to say things twice. I simply must have communications while I am with the patient or I have moved on to three other things.
I use my iPad to record or to do a video chat.

This particular Sunday it was too busy to retrain the staff to get iPhone numbers and I relied on video recording for communicating what is needed. I used these recordings to review my day.

At the beginning of the videos, I was struck by how even my hair looked and how bright and crisp my shirt was. That changed as the day went on.

There was a 10-week-old, 15-pound mixed breed puppy that had bloody diarrhea. His parvo test was negative, but the test will only be positive on day one through 10 of the disease.

Like COVID-19, if you test too soon, you will miss it. If you test too late, you will miss it.
His fecal exam was positive for hookworms, whipworms and roundworms. (Obviously, since the pre-patent period for whipworms is 12 weeks, the pup had to be older.)

This pup’s intestines were turgid and he had vomiting and diarrhea, that means he needed to be treated for gastroenteritis with IV fluids and hospitalization.
I recommended IV treatment and deworming. A staff member took off with the video to get permission.

Cody came in and said someone said they had been waiting 15 minutes and that was too long and she was going elsewhere. Although it wasn’t the best thing to say, he told her “good luck” and took the clipboard and form back.

We found out later in the day that Charleston was closed because the doctor tested positive for COVID-19. Wheelersburg was not seeing emergencies either. Many general practices don’t have room for daytime emergencies either.
Cody got the C-section dog in the building next. The owner was very demanding about what care he wanted. I smiled because I didn’t have a dog in this fight.

A German Shepard bit my thumb and fractured it. I am not doing C-sections for at least a while. (C-section with a spay is not a problem.)

While I feel very comfortable doing most surgeries with it, tiny lives are not something to risk and besides C-section owners tend to be unforgiving if something goes wrong.
Vanessa is a fierce protector of her Animal ER and its standards, so it was not a surprise when the owner agreed to radiographs and fluids. Meanwhile, she was calling the backup doctor.

The owner expected two puppies on her fourth litter “which none had worked”, but the radiograph only showed one. The other uterine horn had a grey-green nasty fluid with a single pup in the other horn.

Before the first C-section was on the table, a second dog in labor showed up. A beautiful Great Dane, this owner agreed to a C-section and spay.
While I could have done this, there were plenty of things to keep me busy. I did help tie off umbilical cords and assist with neonatal care.

There was a chocolate lab named Maggie that had nonspecific signs. I assumed she had some sort of GI thing going on. Her blood work wasn’t quite right, but didn’t point to anything specific. Her mom wanted to take her home.

I urged that Maggie was too sick to be okay and requested radiographs. Radiographs and the start of a vaginal discharge lead to a pyometria diagnosis. The white blood cell count was not the typical very high, but the sick and dying dog was. She would be next for surgery.

Sapphire looked like a Staffordshire. She was sweet. We kept trying for urine to properly treat her urinary tract infection, but she refused to cooperate. A cystocentisis (a needle directly into the bladder) did not yield urine either. Finally, she gave us ten drops of urine and we had enough for treatment.

Molly came in on a stretcher. We didn’t have any cages and Maggie was in one exam room and Sapphire was in the other, so Molly stayed on the stretcher. Nikki called her spouse for her personal cages. Molly’s ascites was obvious and I tapped the fluid as I finished her exam.

Dr. Bess bet me it was liver. I said I thought it was cardiac and either way the prognosis was poor. Dr. Bess was right, the liver enzymes were very high. Her mom got the prognosis and plan, but Molly died before we could get an IV catheter in place.
Hermione had a vaccine reaction and slight fever. We dispensed subQ fluids and safe pain meds.

I was out of people to help me, they were all busy so I ate three spoons of Vanessa’s chili. I didn’t take time to microwave it, because they were free. I also forgot to take time to pee. That was my last break until I was relieved.

Remey was another pup with GI signs and dehydration. As a puppy, parvo is always a worry. As an ER veterinarian, it is an easy case to see. Do a CBC, fecal and parvo test and the treatment is always IV fluids, IV meds and hospitalization. If the owners don’t want to hospitalize, then subQ fluids meds and home. The ER sees enough to have protocols in place.

Cody and I then saw a nice healer. CBC and chemistry and I have a diagnosis of hemorrhagic gastro enteritis. It is a combination of a virus, a bacteria and stress. It causes dehydration so severe that the blood starts to sludge and will not carry oxygen to the tissues.

They get fluids and I’m a hero. They don’t get fluids and they die. I recommended IV fluids and hospitalization.

Leroy was next on the exam table. He didn’t look too bad, but when I started to do my exam, I realized that he was cold. His systems were starting to shut down. Looking closer, he looked miserable. He had bloody diarrhea, but had veterinary vaccines, so parvo was unlikely. The owner chose to skip blood work and go straight to treatment. A few hours into treatment Leroy died.

Two pups came in from a rescue. I had seen them last week when I was at the ER. The whole litter had parvo. Now they looked like they were starving. This was NOT because they were not being fed, but something was keeping them from absorbing the nutrients.

I upped their dewormer and checked on plasma for a transfusion, but we didn’t have any to give. When it slowed down, we would check about a transfusion.

Then there was a cute little Schnauzer. He was so weak that he couldn’t stand on the table, his legs would just slide. His blood work looks good but there is a type of heart disease that Schnauzers get. These guys need a pacemaker. We don’t do that here. Ohio State would be a good place to go.

Jazzie the cat is not happy to be at the ER. Now that I am safe a week later, I get my team to watch the video of the cat from… well, let’s just say it’s not in a happy place. She has diarrhea, but I don’t think we can safely get blood work. I do a physical exam in the carrier with a towel as a protector. I palpate the abdomen and listen to the heart all while Jazzie is threatening to gut me and gnaw on my intestines. By the way, the video also shows my hair is now sticking up at angles and my shirt has various spots and wrinkles. I suggest subQ fluids, some drugs and good luck to the regular vet if it doesn’t clear up in a few days.

A beagle named Tex is in for HBC. When he was hit by a car, it caused open wounds. We took rads to assess the lung damage and recommended fluids. There was a rock in the wound, but with lidocaine and probing, I couldn’t quite get it to pull it out. I left the wound open to hopefully the body will work it out.

Snowball was an older drooling TNR cat. Trap Neuter Release cats have an ear tipped to show at a distance that they have been fixed. This cat had a tumor on her intestine and she was supposed to have a CAT scan, but the doctor that was to give it had COVID-19. Snowball was in bad shape and died during treatment.

Diablo came in for non-specific pain. The 10-year-old brindle was painful, but not at any joints. I thought it was abdominal pain. We did a CBC/Chem, but it still did not point to a specific spot that would have caused the pain. IV fluids help everything and fix minor problems.

Somewhere in here, we saw a dog with a squinty eye. I remember doing a Shirmer Tear test (it passed) and a fluoresceine stain. That also passed. I flushed the eye out well and sent home some ointment.

Normally, we would put them in a cage to get them checked out, but we had no cages. We had no free exam rooms. We had pop up cages with animals and animals on the floor if they were nice. This dog didn’t play well with others. As I sent it outside, Cody said he didn’t think the owner would leave without his ointment because he had driven from Charleston and waited two hours. I hoped I would be as good a pet owner if it were my dog.

Unfortunately, other clients weren’t as nice about the wait. I was working as fast as I could. So, was my team.

Boo was a fairly laid back cat. He was in for open mouth breathing. At this point we were out of cages. Boo came in the building only because he could have been dying and had a carrier. Still, he was not examined first. I checked on him several times, but he was breathing okay and waited. He did get his exam and blood work and rads. He probably had feline asthma. It has some similarities to human asthma, but all we could do is treat and tell her the presumptive diagnosis and advise that she follow up with her regular vet.

I don’t remember who the white cat with one blue and one green eye was. He had an aural hematoma. Something had made him shake his head until the ear cartilage started to bleed. There is not elastic tissue in that area to contract and stop the bleeding. I drained it and put in medication. It is best treated at 3–5 days and this was day one or two. It may have to be retreated.

Everyone on the ER staff worked during my shift. Megan and Cody stayed four hours after their shift was over. Other folks did too. I didn’t know when their shifts were supposed to have been over. They have been trying to hire for a while.

A team member worked while sick and everyone was exposed when they tested positive.

Most, if not all, are negative now. I dare say they were finally happy that I repeatedly coached them on proper mask wear.

I do know I was happy to see my relief. My feet and lower legs hurt. She quickly went through the cases. I had relieved her in the morning, so she remembered her cases. She went on to do a gastric dilatation and volvulus surgery that night with whatever else continued to come in.

I was grateful I did not get caught by a stoplight when I headed home.

MJ Wixsom, DVM MS is a best-selling Amazon author who practices at Guardian Animal Medical Center in Flatwoods, Ky. GuardianAnimal.com 606-928-6566