Dr. J SAYS: OCT.21, 2014 Tracee came in recently for a morning appointment, clearly concerned for her dog Whiskey. He had been vomiting repeatedly since about 4am that morning, and was a bit lethargic. As a one year old pup (Swiss Mountain dog), he was already notorious for his dietary indiscretion- socks, toys (including lego) and underwear had all been previous conquests, without apparent consequence. Upon examination, he was noted to be mildly dehydrated, and his intestines were quite gassy (borborygmus is the correct medical term- Candice always has fun with it). About 10 inches anterior to his rectum, a firmness could be palpated in his abdomen; it wasnt anything specific. Tracee and I had a long chat. There was much to consider. The repeated vomition in a young dog with a history of dietary indiscretion was highly suggestive of a foreign body. We could do xrays, but there are limitations to what we can pick up- radiodense rocks, coins, etc., are easy to define, but socks, plastic and many other items are less easily diagnosed. Exploratory surgery was also an option, but clearly it is highly invasive. I have (touch wood) never had an Oops! moment, but recall many years ago the veterinarian I was working with doing an exploratory and entering the stomach to retrieve what was obviously an ingested ball. Much to my colleagues and my surprise, the explore was unproductive- what was suspected to be the ball was clearly just a pocket of gas in the stomach. Hard to explain that one to the client... Another choice was conservative medical treatment- administer meds and IV fluids, and see how we made out. Something told me that was not the best option- Whiskey was already depressed, and still in the midst of vomiting. Waiting and seeing without knowing the exact problem didnt feel quite right (sometimes theres alot of science to veterinary medicine; sometimes a dash of art is also incorporated!) The last choice was an abdominal ultrasound. Medically, I felt that was the best alternative in terms of informational bang for the buck. It would definitively tell us if there was a foreign object, where it was, if there was any damage to the intestine, and whether surgery was indicated. It is entirely non-invasive. Tracee agreed with this approach. At Small Creatures, we try to never tell people what to do- rather, we strive to give them choices, and guide them with what we think might be the most reasonable approach to any given situation. It seems to work well for us. By early afternoon, Whiskeys abdominal ultrasound was being performed by Dr. Alex Bratton, a board-certified veterinary radiologist at Boundary Bay Veterinary Specialty Hospital right here in Langley (what serves as the emerg clinic at night, now doubles as the referral hospital by day). Dr. Bratton phoned us immediately after the scan was done, and then sent us her report. It read: In the mid jejunum (mid cranial abdomen) there is a segment that is moderately to severely dilated (up to 2.5 cm diameter and 5-6 cm in length) by hyperechoic material that casts a clean acoustic shadow. In her conclusion segment, she wrote mid jejunal obstruction (foreign body). When speaking to her via phone, I asked her if surgery was indicated, and if it was urgent. Her answer to both questions was a definitive yes. Whiskey returned to Small Creatures that afternoon. Once we had tidied up our afternoon appointments and done a little rerouting, he was up. By 4:30, he was on the table. By 6:00 he was sitting up, after we had surgically recovered a 4 long severed rope chew toy from, you guessed it, his mid-jejunum. The next day, he went home none the worse for wear or tear, but probably wondering what the heck had just happened to him in the past 24 hours! We write because the above sequence of events is a good example of the speedy, high quality services that can be offered by a veterinary practice today. If correct choices are made, we can examine, diagnose with a board-certified specialist, perform life-saving surgery, hospitalize, and provide all that is necessary in between. All within a 12 hour time frame. Quite remarkable, really. We are very fortunate to have access to some highly specialized veterinarians (internal medicine, surgery, oncology, radiology, neurology) right here in Langley. When indicated, we like to call on them. Christine and Candice are awesome at quarterbacking all the necessary arrangements, making them as seamless as possible. Whiskey, were glad these services were available. Your Mom made some wise, efficient decisions, and you dodged a bullet. Now please promise her this whole scenario will not repeat itself! Cheers, Dr. J
Posted on: Wed, 22 Oct 2014 04:37:10 +0000
Trending Topics
Recently Viewed Topics
© 2015