Monday, October 29, 2012

The Weirdest Case: One Sick Puppy

We have a guest blogger!  Dr. Jordan Towns wrote this piece about one of the stranger cases that we've seen in a long time.  This case has a happy ending and we've been delighted to see the patient for something as mundane as puppy shots and boarding since his first troubles.

a happy & healthy Max

It had been a fairly uneventful night on call when one of the weirdest cases I had ever seen fell into my lap.  The ring of the emergency phone startled me from the mundane task of checking e-mail.  I listened to the list of odd behaviors and symptoms, and promptly called the concerned owners back.  The patient was a young Labrador puppy named Max.  Until that night, Max had been the typical Lab puppy: energetic, loving, and happy, with a bottomless appetite.  However, when the family had returned from work that afternoon, Max was not acting at all like himself.   He was lying around looking uncomfortable, and he hadn’t eaten at all that day.  Something was definitely wrong.

When I met Max’s worried parents at the clinic, I immediately noticed that Max was a very sick puppy.   He tensed when I touched his abdomen, indicating to me that his abdomen was very painful.  Luckily – or so I thought – there is a relatively short list of problems that are likely to cause a sudden onset of a bad belly-ache in a puppy.

Usually a puppy with a sudden belly-ache has either swallowed an object (like a toy), eaten something that didn’t agree with them, or developed a condition called an “intussusception”.  Intussusception was likely; it’s a condition where a portion of the intestine actually telescopes inside another portion of intestine.

The bad news about these potential diagnoses is that they usually require surgery.  However, the good news is that surgery can provide a cure.   The exam and x-rays pointed to an obstruction or intussusception; it was soon clear that surgery was the only way we could pinpoint Max’s problem and fix it.

Max’s parents readily agreed to the surgery, so it was now time for action.  Max was very sick, so he would need a skilled anesthetist to monitor his condition throughout the surgery – this is where Jana, our on-call technician, was ready to help.  There was also a good chance that two people were needed to complete portions of the surgery, and Dr. Bean was happy to come in and assist me with this.   Max was prepped for surgery, and our search for Max’s problem began. 

Soon into the surgery, we noticed that Max’s bladder was enormous - and unhealthy.  It appeared that Max had been unable to urinate, causing his bladder to fill and stretch until it was causing the symptoms that his owners had noticed this afternoon.

This was not what I expected at all.  In fact, this problem is considered extremely rare in a young puppy.  This was certainly not on my radar!

Something had blocked Max’s ability to urinate… and we needed to find out what.  After we removed the urine from the bladder, we noticed many white crystals floating in the urine.  At the time, we did not know exactly what these crystals were, but it certainly seemed that they had been the cause of Max’s trouble.  After returning the bladder to its normal size, we finished the surgery and woke Max up.   We saved the urine sample so that we could send it to the lab the next day.  By doing that, we might be able to determine what the crystals are made of, and what we could do to prevent the same problem from occurring again in the future.

While the surgery revealed the issue and solved Max’s discomfort, we still had concerns.  There was a possibility that the blockage had caused severe and permanent damage to his bladder, meaning that Max might not be able to urinate on his own.  We made the decision to leave the urinary catheter in place for a few days and provide supportive care; this would give Max’s bladder an opportunity to heal.  At that point, all we could do is hope and pray and wait. 

The next morning, Max was acting just like a normal Labrador puppy again – barking, eating, and walking about his kennel asking for attention.  While we were all excited to see the progress, we knew that we’d still have to wait a few days to find out if Max was really going to be okay.  The test results returned and gave us some clues as to what caused Max’s problem.

It appears that Max had a urinary tract infection that created an ideal environment for the crystals to form in his urine.  Although this was still an unusual occurrence in a young puppy, we were happy to have some answers.  Max did very well throughout the rest of the day.  That night, however, he managed to pull out his urinary catheter.  It had only been 24 hours since the surgery, but I was hopeful that his bladder may have healed quickly and he would be able to urinate.  However, that was not the case – the next morning, Max seemed uncomfortable and appeared to be straining.  A quick ultrasound revealed a very full bladder.  Max was still unable to urinate on his own.  Max was anesthetized once again, and the urinary catheter was replaced.   He would need to remain with us for a few more days.

Max continued to act like a normal Labrador puppy over the next few days.  That Saturday marked Max’s 5th day at the clinic, and he was starting to get a bit restless (well, he had been restless… he is a Labrador puppy, after all!).  Max’s bladder had been given 4 full days to heal, so the decision was made to remove the catheter.  Prayers were said, and the catheter was removed.  Within a few hours, to our joy and excitement, Max proved that he was able to urinate on his own.  Max’s parents were ecstatic to hear the news – their beloved Max could come home!

Tuesday, October 2, 2012

Nice People

Toby, enjoying Dr. Bean's gift from a client 

Welcome back to the blog-

Summer is gone, and things are a little slower at the clinic. That leaves us more time to talk to you about the things that go on here (as well as digging up some ghosts from my past, on occasion). It feels good to be back.

I wanted to dedicate this installment of the blog to some folks who have been exceptionally generous to us lately. The things that they’ve done have brightened up some rough days. I don’t normally name names in the blog, but I’ll make an exception for this one. There are some folks in this world that make life better, and they never get any press. Nice people deserve some recognition.

A few weeks ago, Mr. Thomason came to the clinic with his dog, Freedom. Freedom is a beautiful blue merle Australian Shepherd. She came in with some GI upset that, in the end, turned out not to be life threatening- despite the fact that she did lose some blood. When she first came in, I was admiring her owner’s Thundercats t-shirt. Thundercats was one of my favorite cartoons as a kid. I even had the comic books. Well, a couple of weeks after Freedom’s troubles were over, Mr. Thomason showed up with a thank-you card and a Thundercats shirt for me.  It rocks.  I wear it when I pick up my kids at school, despite the fact that only the parents have any idea who the Thundercats are.

We’ve got a couple of clients who bring in a healthy dose of humor.  Mr. Woodrow usually snips out anything animal related and funny from the newspaper and shares it with us when he comes in.  We always enjoy circulating them among the staff.

Ms. Kenny, a clever woman with an artistic bent, came in to get one of her pets checked out the other day. When the appointment was over, she said  “Hey, I’ve got something for you.”  From under her chair, she pulled out a bright blue, doll-sized stool.

I was puzzled.

“I know it’s kind of small, not like a real stool… it’s more like a stool sample.” she said.

I had to laugh. You can see the "stool sample" above in the picture with Toby.

Food is always a big hit at Branchville Animal Hospital.

The Cole family has a pack of small, white Chihuahuas. It might be more appropriate to call them a herd. They’ve been coming in for years. In the Cole household, there are some very accomplished dessert chefs- their creations rival what you see on the Food Network. They’ve sent so much sugary goodness our way in the past few weeks that we’re starting to wonder if they bought stock in an insulin manufacturer.

We get a lot of fresh produce as well.  One day last week, I came back from lunch and found a bushel of peas, a dozen ears of corn, and a sack full of banana and jalapeno peppers in my office. I had no idea where it came from.  As it turns out, some of the clinic neighbors, the Wilsons, put a bug in the ear of one of their friends, Mr. Honeycutt.  They had told him how much I had enjoyed the Wilsons’ produce that Mr. Honeycutt decided to bring me some as well.  Mr. Honeycutt and his dog have been coming in for seven years now- their first visit was right at a month after we opened. I had no idea that he was an accomplished gardener until last week.

One last specific instance:
One day, we had had a particularly bad morning. We had been working with a couple of families saying goodbye to pets after long illnesses. We also had some first time clients angry with their neighbors over what could be a poisoning case.  The receptionists (the most difficult job in the clinic, by the way) had been dealing with this high-pressure environment- helping some grieve and helping to calm frayed nerves.

We finally got things slowed down when Mr. Pike came through the front door, laden with fresh tomatoes from Sand Mountain. The mood changed instantly. It was a miracle of timing. Later on that day, I was looking at the big brown box full of bright red tomatoes in the clinic break room and thinking: just when you start to lose faith in humanity, in walks Mr. Pike with a box of tomatoes.

Good people are everywhere. I feel lucky that so many of them choose to come see us.