A Veterinary Journal by Claire Poole
March
Chapter 3 - Page 12
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Chapter 1
Chapter 2
Chapter 3
Tuesday 31st March
Tuesday 31st March
Four nights ago, I paid an emergency visit to old Bert, an old mongrel belonging to Jenny, a favourite client. While Jenny was away on business, Bert was staying with Jenny’s parents, but was having increasing difficulty with his legs and breathing. Really, he was deteriorating badly and was ‘Just done’ as Jenny’s mum aptly put it. As Jenny was due home the following day, I gave the old dog some treatment so that he could be put to sleep with his owner present. By the next day however, Bert had staged an amazing recovery and tripped round the surgery, wagging his tail and investigating corners. Both Bert and Jenny had a stay of execution, but the improvement was sadly but inevitably short-lived; this morning we put the old lad to sleep after he took a turn for the worse. Occasionally, this happens - treatment produces an unexpectedly good short-term response in a gravely ill patient - we call it the swansong syndrome. It can be an extra precious few days for a devoted owner, but it is also very hard on the emotions.
Today has produced two pending cases ... ones which might blow up into major problems. The first is Jeff, a spaniel with a persistent nosebleed. Not only has his nose been bleeding since last night, but on examination he also has pinpoint haemorrhages on his gums and small bruises under his skin. This rings warning bells - either a blood clotting disorder or possible poisoning with rat poison. The latter is a distinct possibility as the property next door has been laying bait. Investigation finds that the poison used is related to Warfarin, a drug which prevents blood from clotting as it should; the rodents die from internal bleeding. So far, Jeff is cheerful and does not appear to have lost too much blood but things may deteriorate. A blood sample is taken before Jeff is given a mild sedative and an injection of vitamin K to aid clotting. His nose is packed with absorbent wadding and he goes home to be kept under close observation. His owners will call with progress reports later in the day by which time the blood tests should be through.
On my way to visit one of Edith McNaughton’s dogs, in my mind, I run through possible scenarios for Jeff. If the bleeding continues, he might require anaesthetising to allow us to pack his nose further; if blood loss still persists, he might even need a transfusion. One or two specialist centres hold stocks of blood but this is not feasible for small surgeries such as this. The blood only remains usable for a short time after collection. In most practices, blood transfusions involve blood taken from a donor animal (Fintry or Kippen) and immediately injected into the patient. Although rough and ready, this procedure can save lives in emergency situations - blood grouping in animals is such that one transfusion without previous cross-matching is unlikely to cause a problem.
Back to the present –Meeny McNaughton. Edith called after hours last night, worried about Meeny. At the surgery, we are all familiar with Edith’s ‘emergencies’ - after our mercy dashes, three happy, healthy-looking dachshunds usually hurl themselves at the visitor. Then follows a search to find a problem to correspond to Edith’s worries. You could say that she cries ‘Wolf!’ I always visit anyway to allay her fears - and in case there really is a problem. Last night, the visit was definitely justified: Meeny was certainly not herself. She was reluctant to move, and even snapped at the other two when they came to investigate. Her back was arched and tense, and her hind legs seemed weak. Matching a diagnosis to these symptoms is not taxing in a dachshund. The breed are prone to slipped discs. Symptoms vary from minor lack of limb control through to complete paralysis. In mild cases such as Meeny’s, strict rest may allow the problem to abate, but more severe symptoms - or worsening of mild cases - often require surgery. Meeny has been confined to her kennel since last night. Today she is still depressed but thankfully the symptoms are no worse. I suspect I will be visiting almost daily until we hopefully see some improvement. Edith adores her dogs and could do with the moral support.
Jeff’s lab results are on the fax machine when I get home - his platelet count is reduced quite considerably but as yet there is no anaemia. As if on cue, his owner telephones minutes later. Reasonable news - the nose bleed has decreased but is still seeping a little blood occasionally, and Jeff is resting quietly in front of the fire. Most of my evening is spent trawling through textbooks for up-to-date information on causes of platelet disorders. I had forgotten how complicated the clotting mechanism is. At the end of the night, my knowledge of bleeding disorders has received a transfusion of its own.
Copyright Claire Poole 2005
