by Abby Deuel
“What’s on the schedule today?” asked Mandy.
“So far, I have received three calls this morning that there are emergencies on their way. We also have a few routine appointments coming in that we will have to see between the emergencies unless any of them go to surgery in which case I will reschedule the routine ones. So you can see that it was quite important that you eat breakfast, Doc. You need to have your game on today,” said Gillian.
“Why do they always come in threes?” asked Mandy.
“I don’t know. I did think we’d be in the clear for a while since Dr. Neptune had a busy day yesterday,” said Gillian.
“How are his emergencies, anyway?” asked Mandy.
“He left a note to say that they had all recovered well. He drove them all back to O’Mally’s this morning to reunite them with the owners,” said Gillian.
“I guess we aren’t on his team in terms of emergency counts. We have to fill our own quotas. Is it a full moon?” asked Mandy.
“Not that I am aware of,” said Gillian. “I’ll have the surgery and x-ray rooms ready in case we need them,” said Gillian.
“What are the emergencies anyway?” asked Mandy.
“Well, two of them come from one family. It seems that a guinea pig cage was brought inside due to the dropping temperatures. Inside the cage was a fairly recent litter of pigs plus the mom. The indoor dog, a Schipperke named Prancer, somehow got into the cage through the night. They have recovered all but one of the pigs. So, the first emergency is to examine the whole litter. One of the pups has a fairly serious eye injury while the others appear fine. The second emergency is that we suspect that Prancer may have eaten the missing pup as he seems to be under the weather himself,” said Gillian.
“I am impressed that you got through that whole thing without laughing once. Good for you,” said Mandy.
“I do try, you know,” said Gillian, breaking out into the laughter she had been repressing. Mandy joined her.
“I appreciate your ability to be serious when required. It is no laughing matter that a food chain may cause multiple emergencies. I can’t say that I am surprised that the Schipperke got to the pigs. That is like putting a pet duck in the same house as a Labrador. Schipperkes were bred in Belgium to be large dogs in small packages that pack a big punch. They used them in boats to help not only shepherd whatever stock might be on the boat but also to keep varmints like rats down. They can’t help themselves. Anything little that moves, they are on it. I have even seen them try to take down deer in an effort to protect their area. In short, they are nuts,” said Mandy.
“This is from the vet who has a Collie and a Pyrenees,” said Gillian. “You are not exactly the breed police.”
“Very true. I have a soft spot for high energy breeds. What is the other emergency?” asked Mandy.
“It seems that an Old English Sheepdog named Charlie is showing signs of bloat. I didn’t mince words with them. I told them just to rush her in,” said Gillian.
“Charlie but it’s a girl?” asked Mandy.
“Says the vet with a female dog named Lyle,” said Gillian.
“True. What was she doing?” asked Mandy.
“She was retching but didn’t vomit anything and she wouldn’t eat breakfast which is unusual for her,” said Gillian.
“That’s it? No bloating?” asked Mandy.
“She has her full coat on. They couldn’t tell at all. They did say she was drooling and that she had some water but threw it right back up,” said Gillian.
“Well spotted. It could be a GDV or it could be a blockage. Either way, it’s an emergency,” said Mandy. “I’m not sure what I would do without you. You do a great job triaging over the phone, trying to tell the difference between an emergency, a worried owner, an appointment that can wait for the afternoon, or someone who just needs someone to talk to. I never would have thought that becoming a veterinarian would be more psychologist than animal doctor. Owners have so much to do with our business,” said Mandy.
“Thanks for the compliment. It is tricky. It helps that I’ve known the the entire town my whole life so I can use prior knowledge to help sift out the truth,” said Gillian. “Looks like one of our routine appointments has come in. We better keep everything moving right along.”
Chapter 25
The first scheduled appointment was a new puppy exam. Gillian filled Mandy in on the story behind the acquisition of this special pup. A few months before Mandy had taken over the practice, this couple had to put their dog down as he had succumbed to old age and arthritis and had no quality of life. The couple, Maude and Louis, had a terrible time with the decision but Anna had assured them that it was time. It was a truly sad day when Chester took his last breath on this earth.
Maude and Louis were retired and lived mostly in an RV. They toured all of the places that they had been unable to see while they were working. While traveling suited their desires, the RV felt far too empty without their Chester, a Miniature Pinscher. They had healed their hearts enough to want another traveling companion. This time, they wanted a small dog that did not shed. They wanted something totally different than a min pin so they would not feel like they were just replacing Chester.
While meandering the country in their RV, they were also catching up on movies that they had not had time to see. Recently, they had seen ‘As Good As it Gets’ with Jack Nicholson. They fell head over heals for the dog featured in the movie which was a Brussels Griffon. Surprisingly, there was a reputable breeder along the route back to their home base in Crestview. They pounced on the opportunity and low and behold, the breeder had a litter with one pup not spoken for. It was all meant to be and they were so happy.
“Hello there. You two look over the moon with your new pup,” said Gillian. “It’s so good to see, considering the last time we saw you here. I am so happy you chose to get a new dog. People like you can honor the passing of their pet the most by giving another a loving home.”
“We agree entirely. It took us a little while to feel ready. We know this is the right time and for the right reasons. We couldn’t be happier with this little pup,” said Louis.
“We’ve named her Mabel. She’s already mostly potty trained. We’ve worked with her since Tennessee,” said Maude.
“This is Dr. Mandy Bell. She has taken over from Anna. She has the soft touch just like Anna so I will leave you in her capable hands,” said Gillian.
“Thanks, Gillian. It’s so nice to meet the three of you. This really is a fabulous breed you’ve chosen,” said Mandy. Maude and Louis were grinning from ear to ear, knowing that their new vet knew how special the Brussels Griffon breed was. “Let’s have a good look at Mabel. Has she had any shots yet?”
“Here’s all of her paperwork,” said Maude, handing over a packet of papers. Mandy had a closer look at what Mabel had received so far.
“It looks like she had her first shot at six weeks from the breeder and she is now due for her next puppy shot. They dewormed her at two and four weeks with a broad-spectrum dewormer. My protocol is to check a stool sample for evidence of any parasites and then treat accordingly. I don’t like to deworm without first knowing if there is a reason to, especially in a young pup like this one. Plus, there are some parasites a dog can carry that don’t actually respond to a broad spectrum dewormer,” said Mandy.
“That makes perfect sense. I like what I am hearing. When do we start her on heartworm prevention?” asked Louis.
“She already weighs four pounds and is more than six weeks old so we can start her on this one,” said Mandy, handing Louis a box of heartworm prevention. “It is very important that we start her on a preventative even though the temperatures are already too cold for mosquitoes. For one thing, you travel to warmer areas but, also, in the Midwest, a person should protect their animal all year round from heartworms since we never know when a warm day will sneak its way in.”
“I see. That’s what we did with Chester, too. When can we get Mabel spayed?”
asked Maude. “The last thing that we need is for her to go into heat when we are on the road.”
“My technique requires that the pup be at least two pounds. So, anytime from now on, we can spay her. We have a little while before she will come into heat but I recommend early spaying and neutering since the surgery is so much less involved when they are littler. The incision is smaller which means the recovery time is shorter,” said Mandy.
“That sounds great. It was a long time ago when we had Chester done and I remember him being under the weather for a whole week. We don’t want to see Mabel like that,” said Maude.
“I guarantee that she won’t. As we’ve been talking, I’ve been doing Mabel’s physical exam. I see an extremely healthy puppy here with no abnormalities. I will trim her nails and then she can have her shot. Do you guys have any other questions?” asked Mandy, knowing that she needed to be ready to take in the emergencies as they arrived.
“We have read about crate training. What is your opinion on it?” asked Louis.
“I think it’s a wonderful thing. It helps with potty training by helping to reinforce the schedule you would like to follow. She doesn’t need to stay in the crate when she gets older but getting her used to it at this age will make it easier later in life to use it if you need to. With you traveling the way you do, a crate will make her feel like she has something that is hers no matter where you go. If you do plan on using the crate, never put her in there as a punishment or you will take away the feeling of security that it provides,” said Mandy. “Am I making sense?”
“Yes. We were unclear about it. That helps a lot,” said Louis, holding Mabel in a bear hug as she received her puppy shot.
“She didn’t even notice that you gave her that shot,” said Maude.
“It’s all in the holder,” said Mandy, winking at Louis.
“You may also want to get her a special toy like a big teddy bear. She will bond with it as if it’s a litter mate. It can help settle her when she travels with you. As long as she has her crate and her stuffed toy, she will feel safe and secure no matter where you take her, even if you have to leave her in the RV while you get groceries or something,” said Mandy.
“I hate to be the bearer of bad news. It seems all of the emergencies have come at once,” said Gillian, poking her head in the door. “Also, Gerry has called a few times to talk to you. I told him it would be a while.”
“Oh my. You have your hands full. We will call later to book her next appointment. Thanks again for your time,” said Louis.
“So nice to meet you three. I look forward to our next visit being less rushed,” said Mandy.
Chapter 26
“Alright folks. Let’s do a quick triage to make sure that we see the patients in the best order for their issues. I’ll start over here and work my way around the room,” said Mandy, addressing the three emergencies altogether.
She examined the guinea pig first. It had one eye completely protruding from its head. The other eye seemed to be normal. The pig was stable and not showing obvious signs of pain, remarkably. She moved onto the Schipperke, which was bouncing vertically up and down, as if it was fueled by an invisible pogo stick. The adrenaline of coming into the clinic had overridden the lethargy that the owners had reported. Mandy had a quick feel of his abdomen and could possibly palpate a lump.
“Let’s see if we can get an x-ray on him to see where exactly the missing guinea pig might be. Can you work on that Gillian, while I check the Old English out?” asked Mandy.
“Sure. I’ll do a VD and a lateral,” said Gillian.
“OK, Charlie. Let’s check your belly out,” Mandy said, kneeling down on the floor next to the Old English who promptly sat down. “Stay standing for me, sweet girl. We just need to see what’s going on in there.” Mandy did her best to find any evidence of gas or bloating in a dog that outweighed her. It was rather tricky to use a normal palpation method on this dog so Mandy resorted to a large animal technique. She pulled out her stethoscope and flicked the side of the dog while listening with the hand piece. She moved along the side of both abdomens until she found one spot where it sounded more like a ping than a deep guttural echo. Mandy checked this spot several times to make sure it was a repeatable spot of gas and not just a temporarily trapped air bubble. She also checked the mucus membranes for the capillary refill time which was prolonged, indicating possible shock setting in. Her pulse was just slightly increased and weaker than Mandy would have expected, also supporting the possibility of shock from a stomach flip.
“I’m afraid that I found a suspicious spot of gas,” Mandy started explaining to the owners. “She is also showing some signs that her body is not coping well so we need to move forward. The next step is to take an x-ray to see if we can determine where the gas bubble is. If it is the stomach, we may be able to decompress it by passing a tube under sedation to alleviate the pressure that has built up. If we can’t pass a tube, it may mean that the stomach has flipped. In that case, we will have to go straight to surgery to unflip it. Unfortunately, time is of the essence for Charlie. If there is a flip, the longer the blood supply is cut off, the worse the prognosis. It would be like if I tied a string around your index finger until it turned blue. Initially, it would hurt and then the pain would give way to a numbness as the body shut off your finger from its blood supply. Toxins would build up as metabolic processes continued in the blue part of your finger. If I then undid the string, all of those toxins would be unleashed into your bloodstream at once. Not only can that cause complications, but your finger may also have been without oxygen and nourishment for so long that it would cause more harm than good to the body. These same processes may be happening in the stomach, depending on whether it is a true dilatation volvulus with or without stomach torsion.”
“Do whatever you need to do, Dr. Bell. We can’t lose our Charlie. Since she came on the place, we haven’t lost a single lamb. She is a great guardian,” said the owner.
“I know how important that is. I am right now trying to find the killer of my chickens,” said Mandy. “That is a conversation for another time, though. I will get started on the x-rays.”
Gillian reappeared with the Schipperke and some x-rays.
“Have a look and see what you think,” said Gillian, placing the x-rays on the viewer.
“There is a pretty obvious bunch of matter stuck right there,” said Mandy, pointing to the gastric outlet. “Rather than putting him through surgery immediately, let’s watch him and take a few more x-rays to see if this moves. I’ll let the owners know. Meanwhile, can you set up for a right lateral x-ray so the bubble will be at the pylorus, hopefully anyway. We will need a few people to help us lift her up.”
Mandy and Gillian went their separate ways to achieve their respective tasks. They met up again in the x-ray room to take one of Charlie who laid on the table like a champ. They laid him so they could get the most important x-ray for a diagnosis, the right lateral position. Mandy could hardly contain herself in anticipation of what the x-ray would reveal. Gillian did the honors of developing it. She couldn’t get it on the viewer fast enough before Mandy zeroed in on it.
“Well, we have our answer. Look at the compartmentalization of the stomach. The pylorus has been pushed up by the gas. You sure called it, Gillian. Very impressive. Charlie just got bumped up the list to be our first patient to go to surgery today. It’s going to be a long day,” said Mandy.
“I have everything all set up. I’ll take her on in to prep her for a catheter,” said Gillian.
“Let me go give messages to the waiting room as to what our plan is. I will be right back,” said Mandy. She checked on Lyle and Anna who were playing a game of tug-o-war with a rope toy. They didn’t even notice that she had opened the door to the office. Mandy was glad to see that Lyle had found a friend in Anna. There was only so much a human could provide. Sometimes a dog just needed another dog to play with.
“Alright, Ms., um, I never caught your name,” started Mandy
.
“Mrs. Ryder. Call me Noelle. How’s Charlie?” asked Noelle.
“She does have a build up of stomach gas. We will try to pass a tube to relieve it. If the tube does not move without resistance, it means that her stomach is bloated and flipped. In that case, we will have to go in surgically to unflip it and repair any issues that has caused. My hunch is that we will be going to surgery based on the x-rays but I always try simple first. This may take a while so I would recommend going home. We will call you when we have her in recovery,” said Mandy.
“OK. I will wait for your call. I know she’s in good hands,” said Noelle.
“We will do everything that we can. She is definitely not out of the woods,” said Mandy. She turned to face the family with the guinea pig and the Schipperke. “I didn’t catch your names in the rush of things,” said Mandy.
“Mrs. Garrison,” said the woman who brought in the guinea pig and bouncing Schipperke.
“OK, Mrs. Garrison, you may want to head on home as well. I will give the guinea pig some pain medication to tide it over until we can do the surgery to repair that eye. We will also keep an eye on Prancer to see if that lump of stuff in his abdomen moves on its own. If not, I’ll call you to let you know that we will be retrieving it surgically. Sit tight at home and we will update you as we can.”
“Thanks so much, Dr. Bell. We won’t be able to sit still at home so we will bake some cookies and treats to keep you guys going,” said Mrs Garrison.
Mandy blushed as her stomach growled at the mention of cookies. “We will certainly put those to good use. How thoughtful,” said Mandy.
