Case #1
An owner calls, distraught. Bosco, her 5 year old MN Bloodhound, just got into a fight with 2 other dogs at the park. He has some blood matted in his fur, and is limping on his left front leg. You tell her to come in right away. What things do you include on her initial estimate?
- Emergency exam
- Clip and clean
- X-rays of LF leg
- Medication estimate
+/- bloodwork
Fish, a 7 year old MN domestic medium hair, presents to you for crying in the litter box. His owner reports that it started a couple days ago, but has been steadily getting worse and now Fish just cries and goes in an out of the litter box repeatedly, but the owner isn't finding any urine or bowel movements in the box. What are the top 2 possible causes of Fish's signs?
- Urinary obstruction
- Constipation
Molly is a 2 year old female intact Labrador, who is rushed to your clinic for vomiting, lethargy, and diarrhea. What key history questions are you asking the owner to help determine the cause of her symptoms?
- How many times has she vomited in the last 24 hours?
- Could she have eaten anything she wasn't supposed to?
- When was her last heat cycle?
- Has she been exposed to any intact males recently?
- Is she up to date on vaccines?
You receive a phone call about Scout, a 6 month old male Irish Setter, who came in from outside with a very swollen face and blood on his nose. His owners have no idea what happened, but want to know if they should bring him in. What do you think happened to Scout?
Rattlesnake bite!
A client calls first thing in the morning starting that she would like her pet to be seen ASAP. Larry is an 8 yr MN Golden Retriever who has vomited 10 times in the last 2 hours. You tell her to come right on over, and warn Dr. Westmoreland that a likely ___________ is on it's way.
Foreign body
When Bosco arrives, Dr. Westmoreland is currently in the room with another patient. What signs would indicate that he is NOT stable, and needs immediate assessment?
- Labored breathing
- Pale or blue MM
- Bloated abdomen
- Weakness/ataxia
- Obvious hemorrhage (wounds, vomit, diarrhea, etc.)
You notice that Fish is hunched over and weak, and cries when you pick him up onto the table. You hurry Dr. Westmoreland into the room, and she confirms that his bladder is firm and distended. She starts discussing hospitalization and placement of a urinary catheter with the owner. Why is urinary obstruction life threatening?
- Risk of bladder rupture
- Hyperkalemia can cause heart malfunction
- Causes renal damage
Molly's owner tells you that her last heat cycle ended a few weeks ago, and she has had a poor appetite since then. She has vomited 3 times in the last 24 hours, and is a perfectly behaved lab that never counter surfs. There is no vaginal discharge, but her temperature is 104.0
Dr. Westmoreland is highly suspicious of a pyometra. What diagnostic step is next to confirm a pyo?
Abdominal ultrasound to look for fluid-filled uterus
You tell them you are suspicious of a rattlesnake bite, and to bring him right over. You warn them that treating a rattlesnake bite can be quite costly, and they want to know how you can tell for sure it was a snake bite and not something else. What do you tell them?
- Echinocytes on blood smear
- 2 puncture wounds about an inch apart
- Clinical signs that fit
- Sometimes is just the best guess we have!
Larry arrives and his owner approves bloodwork and x-rays. His bloodwork is unremarkable, and his x-rays show some of gas-distended small intestines along with a curious object. His owner reports that she had made BBQ the other day and Larry is a known counter surfer. Since he is on the older side, his owner wants to avoid surgery if possible. What conservative treatment can be started first?
- IV fluids
- Bulky foods (bread, high fiber W/D)
- Cerenia
Thankfully, your triage indicates Bosco is currently stable. Dr. Westmoreland's exam shows that he has several wounds on his neck and chest, and he is painful in his LF elbow when flexed/extended. You start clipping up all of the wounds so Dr. Westmoreland can explore them with a probe. What is the main purpose of probing the wounds, and what would be a treatment for that problem?
- Evaluate for pockets under the skin and to see if the wounds penetrate the thorax or abdomen
- Placing a drain to prevent seromas/hematoma/abscesses
The owner agrees to hospitalize Fish for bloodwork, radiographs, sedation, urinary catheter placement, and IV fluids. On radiographs, several small urinary stones are noted in the bladder, and one in the distal urethra. If we are not able to pass a urinary catheter past the stone, what is the next step to unblock Fish?
Cystotomy and flush urethra!
Bonus question: if we can't remove the urethral stone at all, what surgery can be performed to allow Fish to urinate?
Ultrasound confirms a large pyometra in Molly. Since she is so sick, Dr. Westmoreland recommends emergency surgery. The owner is hesitant due to cost, and asks if there are any other options. What do you tell her?
Since Molly has a closed cervix and is clinically sick, surgery is by far the safest option.
Antibiotics can be given, however it comes with a risk of uterine rupture and there is a 50% of recurrence at the next heat cycle.
Dr. Westmoreland's exam of Scout reveals severe facial swelling, two small punctures on his right snout, and an otherwise happy puppy. She recommends IV fluids, pain control with opioids, and antivenin.
The owners had another dog several years ago that was treated for a rattlesnake bite with Benadryl, SQ fluids, and steroids, and want to know why the recommendation has changed.
Rattlesnake venom causes clotting issues, which steroids and NSAIDs can make worse.
SQ fluids can cause bleeding underneath the skin, and create a large pocket for the blood to pool in.
Benadryl would treat an allergic reaction, however snake venom is toxic itself, not causing anaphylaxis.
After several hours of IV fluids, a cerenia injection, and continued inappetance, Larry's x-rays show additional gas distension of his small intestines and no movement of the towel. While Dr. Westmoreland is on the phone with his owner discussing the x-rays, he vomits.
What options do we now have?
- Surgery ASAP
- Euthanasia
When probing a wound on his right thorax, Dr. Westmoreland is concerned that the wound may be deep enough to have entered the chest cavity. How can we evaluate if this is the case?
Chest x-rays and evaluate breathing pattern.
Luckily, the urethral stone was not stuck and you are able to push it back into the bladder with your urinary catheter. Dr. Westmoreland sutures the catheter in place, and plans to keep Fish hospitalized for the next few days on IV fluids. His bloodwork showed severe azotemia (kidney value elevation) and hyperkalemia. How long should he be on IV fluids for, and when can the urinary catheter be removed?
- Until azotemia and hyperkalemia are resolved
- Until off IV fluids, and when he is able to remain monitored for re-obstruction, or until cystotomy can be performed.
The owner agrees to surgery that afternoon, and asks what the major risks are, and what the recovery is like. What do you tell her?
Risks: uterine rupture during surgery (contaminated abdomen), bleeding intra-op and post-op, renal damage.
Recovery: Molly will need strict kennel rest for 10-14 days. Antibiotics and anti-inflammatories to help reduce bacteremia (especially if uterus ruptures during surgery). She will likely need to stay hospitalized on IV fluids overnight to rehydrate her and support the kidneys.
Scout's owners agree to hospitalization and antivenin administration. The estimate they signed showed IV fluids and repeat bloodwork in 6 hours. They want to know why are these things being performed?
- IV fluids to correct hypotension and possible dehydration from not drinking
- Repeat bloodwork to look for platelets increasing and monitor renal values
In surgery, Dr. Westmoreland finds a 6 inch section of duodenum that is purple and distended with the hard foreign body. She packs off the area, makes an incision in the intestine, and removes a corn cob. Unfortunately, that purple area of intestine stays purple, and the arteries leading to it do not show any pulses. She also noticed a small tear in the intestine near her incision. What does this mean?
The intestine had so much pressure on it from the fabric that it died and perforated. It needs removed via resection and anastomosis (R&A).
Bosco's x-rays show no abnormalities in his lungs and no fractures to his leg. However one of the wounds did require some sutures and a penrose drain, so Dr. Westmoreland is sending him home with a cone, medications, and instructions for kennel rest for 3 days until his recheck exam. What medications would be appropriate for Bosco?
- Antibiotics (Clavamox or clindamycin)
- Anti-inflammatories (Carprofen or meloxicam)
- Sedatives (trazodone & gabapentin)
Urinary obstruction due to uroliths is more common in dogs than in cats.
What are 3 other causes of urinary obstruction, and which is most common in cats?
- Urethral mucus plug (cats)
- Urethral stricture (previously obstruction from stone, or surgery)
- Neoplasia of the bladder
- Prostatic disease
- Idiopathic
Molly's owner is so appreciative of your care of Molly and her successful surgery. She asks how she can prevent something like this from happening to other dogs?
Spay early, before heat cycles start.
Scout recovers beautifully from his rattlesnake bite, and his owners want to know how to prevent this from happening again.
- Rattlesnake avoidance training
- Rattlesnake vaccine???
There are several post-op complications that we need to monitor Larry for in the next few days and weeks. Name 2 possible complications.
- Dehiscence of R&A
- Sepsis
- Pancreatitis
- Ileus (functional obstruction)