The owners called around 3am. They thought their dog, an English Springer Spaniel, had bloat. We told them there was nothing they could do at home and that they needed to bring the dog in so the vet could examine her.
The other tech and I talked about this after the phone call. Bloat in a female dog could in fact by pyometra, a horrible condition in which the uterus becomes infected and fills with pus. It has to be removed surgically or the animal will die. I've seen enormous canine uteri on the table in surgery, swollen and discolored. Cut them with a scalpel and really nasty fluids come out. Bloat requires surgery too. Either way, my colleague decided to prep surgery and get things ready for an IV catheter and fluids.
Around an hour later, they arrived. We didn't have any other critical care patients at that time so I accompanied the other tech into the room with the couple and their dog. The dog was an intact female. She was panting, hypersalivating, and dribbling urine. She was visibly swollen.
Remember that at this point, we thought that it might be a fairly dire situation.
Before we wake the vets up at night, we collect as much information as we can, including basic physical data such as heart rate and temperature. The dog's temperature was only 99.9 F. Hmm. Pyometra is typically accompanied by extremely high temps (104 or 105 F).
When we took the temperature, my colleague noticed that the dog's rear end was soaked (springer spaniels in full coat have a lot of furnishings on their legs), was sticky, and smelled like tuna. Urine is usually not sticky or fishy. When I held the dog during the temperature-taking, I noticed that she didn't appear painful in the belly which is typical for bloat, her belly was very squishy (bloat would have made it hard), and her teats were gigantic.
The man told us the dog had been "rooting around" in its bedding and behaving oddly for the past few hours.
Without commenting on any of this, my colleague got the basic info into the computer and we left the room. We then looked at each other, compiled all of our observations, and said "she's pregnant. Puppies!"
When the vet came downstairs, the other nurse told him "Dr. K and Dr. D have a diagnosis for you: puppies!" He grunted and proceeded to the room.
In a perfect example of the white coat syndrome, he came into treatment with the dog a few minutes later and told us that the couple told him that the dog had been bred but they thought it didn't take.
Um, let's review, shall we? About nine weeks prior, they bred they dog. They didn't notice the weight gain. They didn't notice her teats getting swollen. They didn't realize that her water broke, soaking her rear end (that's what was dribbling out of her, not urine). They didn't connect the rooting in the bedding with nesting behavior of a bitch in early labor. They called us saying they thought it was bloat. My goodness.
The vet told us to run a blood panel and get an abdominal xray. As a brief aside, I did a perfect one-poke jugular blood draw on this heavily coated animal, my first successful jugular blood sample on a dog. We got the blood sample into the machine and trotted off to xray.
Here's a picture of the radiograph. The dog is laying on her right side with her head to the top of the image. What can you see?
It's important to count both skulls and spines. Here is a doctored image.
She was a little anemic, not surprising with eight parasites inside her and probably inadequate neonatal nutrition, but otherwise there didn't seem to be any problems. She was in the early stages of labor and didn't seem to be presenting with any birthing complications so the vet sent the hapless couple and their dog back home.
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