Every Tuesday evening I get to meet a new set of challenges it seems. I am the late Vet and the darker it gets the crazier the scene seems to set.
Tuesday was another for the blog books. In the middle of the booked evening I had on the schdedule one of my Receptionists came to me to notify me that she had just received a call from a woman who was not a client asking if she could come in immediately because her dog was bleeding profusely from the penis.
“Sure,” I said, thinking this is probably just a urinary tract infection. (I had seen 4 that evening already). This was just going to just be another tick in the evening’s cluster of unexplainable clustering pee issues.
I continued plowing through the appointments and figured I would meet the new client as I looked over some urine the tech had caught from their dog for me before I went into the appointment. I would then begin my dialogue about the physiology and treatment options of UTI’s as I tried to endear myself to the new client in the building.
A short time later I was called by my tech to come look at the dog in Room 2. As I walked in I saw a very timid small badger looking Australian Cattle Dog crouched over a puddle of very dark bloody…. umm, well maybe? urine? I actually wasn’t sure if the puddle on the exam room floor had come from his penis. It looked a iteensy-bit more watery than arterial blood, but not watery enough for me to believe it had come from the bladder, or might be urine.
“OK, not a simple UTI, fabulous.” I thought. Time to rethink the evenings plans. I put my files down and closed the exam door behind me. It was time to meet the new clients and do some investigative work. My tech knew to go into the other rooms and start offering some excuses and apologies.
I gave JD a look over. He was slumped, head bowed, pot bellied, and looking like he really felt crummy. His gums were muddy light pink and dry. He was dehydrated, shocky, had an elevated heart rate, respiratory rate, and a belly full of fluid, (I suspected blood based on his poor mucous membrane color and blood on my exam room floor).
I then turned my attention to the new client. She was a tall woman very obviously 8 plus months pregnant. She also brought her two pre-teen children who were hungry and bored already. We had some ground to cover, lots of questions to ask, and explore, and 2 kids that had better things to do.
When I asked if there was any chance of trauma?, like being hit by a car?, JD’s mom told me that he is never out of their yard. When I asked if he could have gotten into any poisons (like rat poison), she assured me that she lives on a farm with 10 acres and they never use poisons because they raise goats.
I was coming up empty despite my persistent queries and inability to make the clinical signs of this dog fit the history she was providing.
JD’s mom told me that he had been perfectly normal the day before and had seemed a little quieter in the morning but had just started bleeding this afternoon.
I asked her if I could take an x-ray. I was concerned about there being blood in the chest and I wanted to look for radiographic evidence of trauma. She consented. Three chest views, (left and right side down, and ventral (lying on the back)), and side and ventral abdominal x-rays all showed bleeding and clusters of bleeding, but no signs of trauma (broken bones). I returned to the exam room and requested we take blood to run a CBC (complete blood count) and chemistry panel. I hoped to only find a low PCV (packed cell volume due to blood loss) because blood loss was the only clue I had so far.
As I reviewed the diagnostics we had done I again questioned her about the history of this dog. I just couldn’t believe cancer would cause him to be fine one day and then bleeding profusely the next.
JD's PCV was 31%. I was surprised a little because he looked worse than 31%, and his TP was 5. OK, he looked as bad as 5.
The bloodwork revealed anemia, (low red blood cell count), low protein, and everything else was normal. OK, now very unlikely it was cancer. It was an internal bleed, but why?
At this point I had JD’s mom in hysterics telling me that her pregnancy wasn’t going well, she loved her dog but had NO money, and she needed to know what was wrong with him and why.
My night was now significantly running late and going south, fast. Nothing beats stressed out, like stressed out, guilt ridden, and an emotional pregnant woman with a sweet dying dog who needs A LOT of emergency care, and a $2500 budget.
I told her that JD was critical. I also told her that I was not sure why he was bleeding, but if he didn't stop soon he would likely succumb to dying via exsanguination. He had to be transferred overnight to the ICU emergency room. The moment I suggested this to her sobbing turned into firm persistent unequivocal denial of transfer.
“I won’t go there! I will never go there again! They are thieves and they don’t care about us or our pets!” OK, she was adamant and I was losing any hope of this dog making it through the night.
Compromise talking time.
“What if I call the other emergency clinic and see if they can monitor him for the night for less than $200?”
She doubted my ability to negotiate and she doubted their ability to execute a plan. I re-assured her that we all wanted to try to save JD and we all understand that all of us have budgets.
I called the ER and spoke to the DVM on duty. My conversation started something like, “Boy, do I have an interesting case for you!” All I had to say was $200 bucks, 8 months pregnant, and bleeding profusely from the penis and she realized my sarcasm was understated.
JD was transferred with some diagnostics, a long list of unknown answers, and a presumption of toxicosis but nothing to prove or back it up.
Thankfully the ER has the ability to run a coagulation profile, and thankfully it was within the $200 overnight budget. JD’s coags were “off the scale.” He had been poisoned by a rodenticide (likely) and he was bleeding out of the easiest hole his body could dump out of; his bladder.
Overnight I received text messages from the ER DVM saying that "he was holding his own and they had started Vitamin K."
JD returned the next morning whiter, more depressed, and breathing even harder. He now had frank blood coming from his penis. (Frank blood means thick, red staight bleeding). It is a scary thing to witness and significantly worsened his prognosis.
I had to have a difficult discussion with a now exhausted (she was at the ER until midnight), 8 month pregnant, still 2 kids in tow (also overtired), emotionally charged owner. Yippee!
“JD looks worse this morning. I had hoped that the Vitamin K would have stopped the bleeding by now. When I saw JD last night his PCV was low at 31%, and his protein was also low because of the acute blood loss. He is now 19% and his albumin (protein) is at a very dangerous 2. He needs to be transferred to the ICU for blood transfusions and I estimate this is all treatable but will cost upwards of $2000.”
Profuse hysterics ensued.
“OK, plan B: I will do the best I can here.” Crying stopped.
She asked if she and her children could say goodbye to JD just in case he continued to decline and didn’t make it through the day.
I also had her sign a “Consent for Euthanasia” form so that if JD became agonal (started to die) I had her permission to humanely euthanize him.
At 9 am we began our low-budget, no holds barred, quest to save JD. He received 4 units of fresh frozen plasma. (I have had this one treatment save more lives in my clinic than probably anything else. I strongly recommend clinics keep a few units in the freezer. It lasts a year, is easy to give and is really very safe. It saved my own dogs life (Savannah) and it saved JD).
|The magic liquid elixir worth more than gold. The life-saving miracles of plasma.|
After 2 units of plasma JD started urinating almost normal looking urine. Instead of it being frank blood there were only blood specks. He also began to eat, and breathe much easier.
|This is the urine JD left on the towel. We were sooo happy to see only one speck of blood.|
|Lots of fluids means "I gotta pee! A lot!"|
|BIG improvement from the night (and this morning), before!|
After 4 units I called his mom and told her that I thought JD had just dodged another big bullet.
|Pink mucous membranes. Also a BIG improvement from the pale muddy pink of the night before.|
She had told me the day before that he had already survived a fractured skull many years ago.
JD went home last night wagging his tail and smiling, head held high.
He is a miracle and another living testament to early medical intervention and treatment.
|This is what a GREAT Technician does. She sits and hand feeds the patients who need love and encouragement.|
|Eating only because someone will take the time to make everything less scary.|
I also had a visit from the Sheriff yesterday. Seems JD’s mom now believes that the neighbors intentionally poisoned JD.
I know how terrible the effects of rodenticides can be on pets. I am not a person who wants to share my home with rats, but this is a terrible way to die and kills too many domestic pets every year. Someday this product will be banned, but until then I urge all of you animal lovers to pick another way to rid your house of unwanted visitors.After I finished this story I posted a Twitter message stating the following;
"Saved a dog from rat poison ingestion w vit K & fresh frozen plasma transfusion. This stuff kills more than mice, pls don't use it!"
I received a reply from Vet School Style stating,
"I had a guy say he didn't realize that bc it said "rodenticide" and not "dogicide."
JD's PCV was up to 23%, and TP 7.4 the next morning. He is one lucky boy!
He will stay on oral Vitamin K for the next two weeks.
1 week update. JD came to visit and he is back to his happy, energetic, sweet self. His color looks great, and his chest sounds much better also. We put him on anothr 2 weeks of vitamin K because we don't know what kind of rodenticide he got into. Treatment for rodenticide toxicity is 2-4 weeks. We are playing it safe by supplementing him longer.
JD's family came back in with him, and the son confessed that they had done a search of their home and found a box of rat poison. JD's mom tried to convince me that she didn't think it was the poison he got into because there weren't partially eaten pieces, and JD is "too smart to do something that stupid." I told her if they found it, he got into it.
As a side note; I just went into our basement to retreive our kittens who snuck down there (because it is off limits) after my husband went down to find a can of paint. Seems