Wednesday, August 29, 2007

Emergency Vet

No photos tonight. I was too busy playing ER doc to be a photographer. I spent 4 years in an emergency practice (nights, weekends, holidays) where I got a wealth of experience and lived for the adrenaline rush. In my calm, orderly, daytime world, I seldom experience the hectic pace of that old life (and don't really miss it) but it's nice to know I can still "kick it" when I have to.

It was just 6pm and we were closing up after a fairly slow day. My technician was discharging the last patient and I was writing up my charts while the kennel assistant waited for her chance to mop the front floors. Suddenly I heard, "Doc, we have an emergency up front!"

I ran to the front to find a man struggling to get a German Shepherd through the door. She had collapsed literally on our doorstep. I helped him into an exam room and asked "What's the problem?"
She was wet, and I was guessing that she must have had a heat stroke (It was over 95 today) and they had wet her down before bringing her in. Wrong. Turns out they had been bathing her outside by their back fence when she was attacked by a swarm of yellow jackets.

I started my assessment immediately - gum color, capillary refill time, heart rate - all within normal range.
Respirations - a little rapid, OK. She was recumbent and not very responsive, which worried me. But, my biggest concern --- she was covered in yellow jackets. Several had flown off when she entered the building and were buzzing around my reception area, causing the two young boys of the family to scream and cry. I killed 4 that were in her ear, and many more from her body. All told, we removed close to 2 dozen yellow jackets in the office, and I don't have a clue how many stings she must have had - dozens for sure, maybe hundreds. Who had time to count?

My tech followed me into the room and we completed our triage and had an IV catheter going within 5 minutes of the dog entering the building. Intravenous steroids and antihistamines, plus shock rate IV fluids soon had her coming around - sitting up on her chest and looking more alert. I didn't feel it was necessary to give her epinephrine, as she was responding so well, but I advised the owner that we weren't out of the woods yet.

Yellow jackets aren't like bees, which die after stinging once. They are able to keep on stinging, and part of treatment is to try to find and remove every last insect. Tough to do in a thick coated dog, with two worried adults and two freaked-out children to deal with. My emergency drugs were keeping the worst of the reaction away, but I knew they would wear off soon, and that the dog needed additional treatment and continued monitoring. We got the dog stable and sent her on to the local 24 hour emergency service for intensive overnight care. I hope she does well: The last dog I saw that was this badly affected died despite our best care.

This story emphasizes the benefit of overnight and 24 hour veterinary ER's. In the old days, I would have stabilized the dog, left her on IV fluids overnight, and prayed that she would be alive in the morning. Now, I consider "emergency care" that consists of the vet coming in, hospitalizing the pet and going home to bed as tantamount to malpractice. I know there are areas of the country that don't have 24 hour facilities readily available (I have lived and practiced in several such areas) and I know that vets do the best they can. I personally have made many late night trips to check on critically ill pets or napped on the floor near unstable patients in the past. I also know that I don't miss the lack of sleep, the worry wondering if there was something else I could have done, or the sick feeling of coming in to work the next morning to find a pet "dead in cage."

Two lessons from tonight's event: 1) Yellow jackets can cause life-threatening toxicities and 2) When your vet refers you to an overnight or 24 hour emergency service, it is because s/he has your pet's best interests at heart.

Update, Thursday, 5pm: Tia is doing well. Although I was off today, I couldn't wait to hear about her and called the emergency practice at 8am. She lived through the night, and was expected to be discharged today. Hip, hip, hooray! A "save" always makes me feel good.


Susan Gets Native said...

I mean, damn.
So much for your slow day, huh?
Hope the Shep pulls through!

KGMom said...

WOW-scary. You could use yellow jackets for toxic Tuesday!
Years ago, my husband disturbed a yellow jacket nest and was stung many times. He puffed up in short order!
Poor dog--hope she makes it!

Anonymous said...

Thank you for sharing your experience with the yellow jackets. I hope the dog will be okay. Such an ordeal for her and her family. I'm glad you were there to help her! Kathy

Anonymous said...

You are wonderful to provide the care and your attitude reminds me of our own veterinarian. I wish I had as much faith in my own medical doctor as I do in my veterinarian. He saved my dog's life once, and later helped us know when it was time to let her go.

Kudos to great vets! And just a reminder folks: take cookies, brownies, or other goodies to let him/her know how much your appreciate the vet and the staff. Write a note to your canine doctor to express your gratitude again.

We recently moved to another state, and my biggest concern was losing my vet. I knew I could find a new medical doctor, but choosing a new vet is even more difficult.

Since you seem to be one of the most competent and caring, perhaps you might blog about ways to find a new vet.

littleorangeguy said...

I hope good things for that poor dog and his family too. And am thankful that we have a 24 hour emergency clinic here -- one long weekend our clinic was closed and we took our kitten to the emerg after he got stung (chasing bugs)and seemed to have a reaction. He was fine, but I was so happy we had that resource.

On another matter, Kathi, I received you note via our mutual acquaintance and tried to respond twice but my server tells me it didn't work. Long story short: thanks, and A-OK.

Anonymous said...

So glad that Tia is doing well! My dog has no fear of yellow jackets. She snaps at them until she kills them, even when they sting her mouth. I hope she never stirs up a nest of them, or we'll be heading to the vet's office. Kathy

Julie Zickefoose said...

Poor ol' Charlie got stung about ten years ago, on the white face patch (he's a macaw). It swelled up to the size of half an English walnut. It was a Sunday, of course, and no emergency vets here had much idea what to tell me about a macaw that had been stung. When I finally got hold of Don Burton at Ohio Wildlife Center, he said, "Well, he'd have died by now if he was going to die."
He recovered uneventfully but needed a whole lot more cuddles than usual. Yellowjackets. Pah.
Best wishes to Tia and to you, brave KD.