Wide Open!

We are fortunate to have a guest blogger for this post, Dr. Wendy Fraser.  Dr. Fraser is currently out on maternity leave but left us this blog to enjoy in her absence.  Congrats again to Dr. Fraser and her family on their new baby girl!

I am a huge television fan.  It is truly one of my guilty pleasures.  After the kids are finally in bed I like to sit down, relax and let my mind focus on the intriguing plots of Mentalist, House, Criminal Minds and the like.  My selections are admittedly intellectual junk food.  Why do I like these shows so much?  I like them because in one short hour a mystery is solved.  There is always a rewarding answer at the end of an hour, everything is neatly wrapped up and everyone is satisfied.  That rarely seems to happen in real life, particularly in veterinary medicine.  I like the fantasy that everything has an answer and if that answer can be found in under an hour so much the better. 

Real life is much more frustrating.  For example, one Tuesday morning when working at another clinic in the Birmingham area, an owner called about a sick German Shepherd.  The owners were concerned because the dog would not come out of the dog house.  The receptionist recommended that the owners bring the dog in for an exam.  We went about the usual workday until late afternoon when the receptionist said, “I think that sick dog that wouldn’t get out of the dog house is here.”   There were no clients in the lobby so I was curious as to how she knew that that particular dog was here.  When I walked up to the front lobby and looked out the window I knew how she knew:  a truck had pulled into the parking lot and on the back of the truck was a HUGE doghouse.

The driver of the truck and his companion had begun to unload the dog house and carry it into the clinic.  The dog that wouldn’t get out of the doghouse was now in the lobby, doghouse and all.

I started to take a medical history from the owners.

How long had the dog been in the dog house?  Two days.

Has he eaten anything?  No. 

Does the dog ever run loose?  Sometimes. 

Inside the dog house was a 70lb, 3 year old German Shepherd lying on his side, his eyes were unfocused but he was breathing steadily.  To the side of the dog were some scrambled eggs and there were two pieces of toast on top of the dog.   I took the top off of the dog house, dusted off the eggs and toast and moved the dog to an exam table.   At first, the dog appeared to be in great health.  He was a healthy weight, had no skin lesions, was staring straight ahead and breathing deeply.   All the vital signs appeared normal.  What do I know about the dog at this point?  He was young, was healthy three days ago, doesn’t have an appetite for eggs and toast, and is in a coma.  That was all the information I could gather and when presented with a case such as this you have to consider all factors, even beyond what the owners tell you (for any other TV junkies out there, think… House.)  These owners would like to do whatever they can to help the dog.

At this point, my diagnosis of the dog is open, WIDE OPEN.  This means that I have no idea what is wrong with this dog!  Typically in a case like this Dr. Bean, Dr. Compton and I put our heads together and come up with what is called a differential list of possible causes and try to pick diagnostic tests that will help to rule in or out any of the illnesses on the differential list. That’s exactly what I started to do.  The most likely causes in this case were trauma or toxins because the dog wasn’t skinny or sickly looking, indicating that it had not been ill for long.  He looked great and was in fact a beautiful dog.   

It had been almost an hour since he arrived at the clinic and I was still not close to solving this one.  Unlike on those medical dramas on TV, dozens of assistants had not appeared to take samples and whisk my patient away for tests.   I drew blood samples to send to the lab and treat for dehydration, infection and inflammation.  My only options now were to wait until the next day for his blood work results and monitor him for responses to my treatments.

The blood work results from the next day were normal.  We tried every reasonable course of treatment but nothing that I did seems to change the dog’s condition.   After 3 days the owners elected to euthanize him.  Many, many hours were spent thinking about this dog and there was no satisfying answer at the end.  All that we have are unanswered questions, frustration and sadness.

So, how do I cope with cases like this?  I go home, put the kids to bed and watch an hour of junk!