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!

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