When I started picking up the occasional Saturday shift at a local clinic, I insisted that I only wanted to see wellness clients. But not every pet that comes in just needs an exam and vaccines. Ears, skin, vomiting, and diarrhea cases began showing up on my schedule, although I am still able to duck lacerations and other cases that required suturing. (This clinic only does dentals and surgeries during the week, so that was never going to be a problem.) The reason is that I simply don’t trust my skills with cutting and suturing living animals. I’ve developed habits that help me do necropsies efficiently but these absolutely do not translate back into the GP world.
On a recent Saturday, things shifted quite a bit, taking me pretty far outside that wellness bubble. A regular client came in with their 14-year-old Chihuahua laterally recumbent and unresponsive. The dog was being treated for congestive heart failure, a chronic, progressive disease. The other vet working that day and the entire team of techs jumped into action, setting up for intubation, oxygen, placing an IV catheter, giving drugs, and performing chest compressions. It was impressively smooth and professional teamwork. Realizing that I could contribute nothing to that effort, and at best would only be in the way, I focused on the owner, collecting more history, giving her information, and helping her work through the many decisions that she needed to make quickly. I work with grieving owners all the time in my job at the lab and am comfortable communicating in that setting. Sadly, they couldn’t restart the dog’s heart.
Of course, I received training in how to treat these kinds of emergencies. But I haven't applied that training in over 7 years. Like any specialized knowledge, if you don't use it regularly, it atrophies.
But that wasn’t the only curve ball thrown on this day. The last appointment of the day, assigned to me, arrived around 5pm. The owner had taken the dog, a 2-year-old female pitbull mix, to a low-cost spay and neuter clinic two days earlier. The dog had developed severe bruising on her abdomen and was “dumpy” and lethargic at home, although she still had an appetite. The dog wasn’t messing with the spay incision site, which was a bit scabby but healing. However, there were massive, dark purple bruises on her abdomen and large pockets of fluid under the skin. Alone, these weren’t an emergency even though they looked scary. Large, deep-chested dogs can sometimes be difficult to spay and there can be trauma to the body wall, leaving bruises and subcutaneous edema. But it was the reported lethargy that set my spidey senses tingling.
I’ve seen the absolute worse cases of post-spay deaths presented for necropsy, including ligatures coming off, cutting but not ligating ovarian arteries, accidental avulsion of renal vessels, complete transection of the intestine (we still don’t know how this happened as one does not insert scalpels into the abdomen for a spay), and contamination of the abdomen or the incision site. There are lots of ways for spays to go wrong.
The dog’s physical exam was normal. The owner reported that the dog had pooped since the surgery. Still, the case just didn’t feel right to me. I said, I want to run full bloodwork. And it turned out that the dog had a severe, active infection. If the dog didn’t receive immediate treatment, it would probably have died. We sent the owner home with 14 days of a broad-spectrum antibiotic plus a steroid for inflammation and another drug to address pain.
Regular GPs see these kinds of cases every day. This was a normal Tuesday, or rather Saturday, for that clinic.
I’m a decent diagnostician, and as I learn more about the pharmacy available at this clinic, I get more confident in selecting tests and treatments. But I still have a lot to learn. I am lucky that my forays into GP veterinary medicine are being supported by such a well-trained and compassionate team.
