Fun Cases!

[battie]

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But then owners have this double standard that chopping off the leg is cruel when the critters are walking the next day 🙄

 

[fauna]

Yeah almost every THR I was on at UF was some variant of doodle monstrosity. One of them was also in heart failure at 4 years old as well…. Immaculate breeding clearly. We send home a boat load of sedatives for every THR. Orthopedic surgery is literally insane, kudos to those that do it. Totally not your fault, owners are told strict crate rest for a reason. We still have dogs luxate their implants occasionally because “being locked up is cruel.

Haha, my coworker has a scrub hat that says “your doodle is a mutt!”

This ray of sunshine also kicked me in the face post-op sooooo yeah, maybe she should have gone home with more than the usual gaba traz.

I also did an overhaul of our go-home documents after this. Don’t get me wrong, her owner’s instructions were INCREDIBLY clear both at the consult and at discharge. But, I just edited them and made it even more clear and added some safe enrichment activities to do at home during recovery.

I don’t understand spending thousands of dollars on your fancy dog. Then, spending thousands on a THR. And NOT taking the care and caution necessary to preserve that.

 

[fauna]

But then owners have this double standard that chopping off the leg is cruel when the critters are walking the next day

Hey, well, don’t forget about the CRUEL E-collar that they’re not going to keep on!

 

[katiemcat]

Haha, my coworker has a scrub hat that says “your doodle is a mutt!”

This ray of sunshine also kicked me in the face post-op sooooo yeah, maybe she should have gone home with more than the usual gaba traz.

I also did an overhaul of our go-home documents after this. Don’t get me wrong, her owner’s instructions were INCREDIBLY clear both at the consult and at discharge. But, I just edited them and made it even more clear and added some safe enrichment activities to do at home during recovery.

I don’t understand spending thousands of dollars on your fancy dog. Then, spending thousands on a THR. And NOT taking the care and caution necessary to preserve that.

…😂

 

[fauna]

…😂

Dude!! I don’t even have crocs and I want it!

 

[battie]

This ray of sunshine also kicked me in the face post-op sooooo yeah, maybe she should have gone home with more than the usual gaba traz.

Our major Ortho surgery center south of me sends things home with ace. My Pittie went home with 250 tabs of ace for her recovery

 

[katiemcat]

Our major Ortho surgery center south of me sends things home with ace. My Pittie went home with 250 tabs of ace for her recovery

Yeppp so do we. I think it helps a lot.

 

[battie]

Yeppp so do we. I think it helps a lot.

My girl has spay incontinence and on proin. While on the gaba, traz, and ace, she would re develop the urinary incontinence. That's how I knew she was the right amount of high.

 

[fauna]

We had a lot of owners feel really hesitant about ace, or just straight up not compliant. They said it turned their poor babies into zombies. One of those things where you want to listen and validate their concern but also we want them to be couch potato zombies after surgery! Seems like more of a client education problem than an acepromazine itself problem, something I have voiced to the doctors before.

 

[pp9]

We had a lot of owners feel really hesitant about ace, or just straight up not compliant. They said it turned their poor babies into zombies. One of those things where you want to listen and validate their concern but also we want them to be couch potato zombies after surgery! Seems like more of a client education problem than an acepromazine itself problem, something I have voiced to the doctors before.

Balance between owner expectations and reality.

'My dog just got a new hip/fracture repair/foreign body removed/etc, they should be running around again and feeling amazing! Why are they so drunk/sedate? Did you make her worse? She isn't hungry, is she dying? You've made my dog worse!! This sedative/pain med is KILLING MY DOG!!!'

Throw in the 'the ER vet said you were a terrible vet and the drugs were wrong' (I said no such thing) for extra points, triple bonus if the pDVM calls me to rip me a new one over it.

Signed,
Someone who burned out of FT ER in the most spectacular way 😒

 

[overcastkidjuno]

Ok, this isn't a program/case I've been involved in BUT I needed to share this with you all anyway.

Animal Rescue League of Iowa is doing a TNR program where you can pay 15 dollars to name a feral cat after your ex & have it neutered/spayed as revenge. I have never seen such a hilarious TNR program in my life, look them up if you haven't seen it yet!

 

[battie]

Had a fun one recently!

12 yr old FS Puggle presents as transfer from rDVM. She had earlier collapsed on a walk. On intake very bradycardic, pale, hypotensive. rDVM scans abdomen and finds 0/4 fluid but a gall bladder halo. Hazy on the details, but remains bradycardic despite fluid boluses. She gets three doses of epi prior to transfer. Patient is a historically well controlled addisonian as well and has never missed meds. Overall, suspected anaphylaxis event.

Presents to day doc. She still sees the halo sign. Starts fluids, does some dex so, and schedules her for q 6hr FAST scans. I come on at 8pm. Girl has now become tachycardic, but doesn't act like it.

We get to 11pm so I stroll the ultrasound machine over. Yep, still no free fluid and still a gall bladder sign. Then I go for the thorax. Guys. HOME GIRL HAS PERICARDIAL EFFUSION.

I shout, "OH ****!" My technician is doing stretches, my assistant is in the bathroom. "WE HAVE TO TAP THIS DOGS CHEST NOW!!" Both of them are at the crash table in seconds getting **** ready as I get the dog off fluids and to table. Boom some torb. Boom prepped and ready. Boom fluid removed. Only pull 4mls of blood and there's some left, but don't feel too comfy with how it's pocketing and don't attempt another stick. Dog's heart rate instantly drops from 180 to 80. She's suddenly super comfy and lovey. Takes awesome naps except when I wake her up to scan q 2hrs. Call mom three times before 1. Suspected mass seem, though I ain't no cardiologist.

The next morning, I'm on the phone with the owner as the overnight doc comes in. Tell her she can take our cardiologist and at home euthanasia list home after pick up. Day doc is the same as the day before and she's now wondering why the hell I'm talking about death and specialty. So she reads the chart and her face gets the shocked look.

Ultimately suspect homegirl collapsed due to pericardial effusion and that's why she wasnt super stable the whole time. The gall bladder halo is commonly associated with anaphylaxis, but can also be caused by pericardial effusion due to the distention of the portal vein and associated vasculature.

So when doing FAST scans, Fam, check all the cavities!!

 

[Trilt]

I knew exactly where that story was going from the first sentence. I've been the second doctor on several of those and man it really sucks to have to tell an owner that the quite good prognosis they were given for anaphylaxis is very very different now.

 

[Trilt]

Additional fun fact: acute hepatic necrosis can also cause gallbladder wall edema. And right sided heart failure (I see it in almost all my caval syndromes), blood transfusions, auto immune diseases... I wish it were as specific for anaphylaxis as I initially thought.

I had a hypoglycemic puppy that I saw right at shift change and treated like a standard hypoglycemic puppy, the BG kept dropping and the next doc ultrasounded her and saw the gallbladder wall edema - thought anaphylaxis, then her liver values and coags continued to **** the bed and she was diagnosed as an amanita toxicity on necropsy.

 

[pp9]

Additional fun fact: acute hepatic necrosis can also cause gallbladder wall edema. And right sided heart failure (I see it in almost all my caval syndromes), blood transfusions, auto immune diseases... I wish it were as specific for anaphylaxis as I initially thought.

I'm very glad that my internship had us sit through a 2-week ER 'crash course' where I learned this, coming out of school I didn't know gallbladder edema had so many possible causes.

So when doing FAST scans, Fam, check all the cavities!!

For the love of everything, yes. I also used to tell my interns to scan every patient they saw, partly for practice, but partly so you can actually figure out what's going on with a patient before talking to an owner or letting a dog sit in a kennel. I got my hand slapped several times by corporate over it (we were supposed to charge $125 ,iirc, for a FAST scan) but screw it. It should be something that is included with the initial exam and consult on ER. Seen a lot of PCEs and early hemoabs sit and wait because they present for 'lethargy' and no one was doing FAST scans as part of the initial eval/triage.

Also, that dog is lucky to be alive after getting 3 hits of epi with a barely functioning heart!

My fun case this past week: 15ish MN grey wolf was immobilized for a routine (-ish, he's old with mobility concerns) exam. Anesthesia went fine, darting was super smooth, no chasing/running at all. Long story short, RAGING rhabdomyolysis became apparent about 24 hours post-recovery. CK was >75,000, liver/kidney values shot up, he was super weak. No pigmenturia, which I've since learned is not a guaranteed clinical sign although it's a hallmark. After 3 days of getting hands on this wolf 2x/day for treatment, his kidney values are trending down and his mobility is decent enough that he went back on habitat, where we will likely never get hands on him again while he is alive. We can't even tell if he's eating out there, lol.

I've treated rhabdo in a small handful of dogs (usual story is they got loose and just kept running) in a controlled ICU setting with more aggressive therapies and those didn't always end well. I was voting to euthanize this wolf...I'm often in the 'just because we can, doesn't mean we should' camp, but I'm glad he is doing okay.

 

[katiemcat]

Had a fun one recently!

12 yr old FS Puggle presents as transfer from rDVM. She had earlier collapsed on a walk. On intake very bradycardic, pale, hypotensive. rDVM scans abdomen and finds 0/4 fluid but a gall bladder halo. Hazy on the details, but remains bradycardic despite fluid boluses. She gets three doses of epi prior to transfer. Patient is a historically well controlled addisonian as well and has never missed meds. Overall, suspected anaphylaxis event.

Presents to day doc. She still sees the halo sign. Starts fluids, does some dex so, and schedules her for q 6hr FAST scans. I come on at 8pm. Girl has now become tachycardic, but doesn't act like it.

We get to 11pm so I stroll the ultrasound machine over. Yep, still no free fluid and still a gall bladder sign. Then I go for the thorax. Guys. HOME GIRL HAS PERICARDIAL EFFUSION.

I shout, "OH ****!" My technician is doing stretches, my assistant is in the bathroom. "WE HAVE TO TAP THIS DOGS CHEST NOW!!" Both of them are at the crash table in seconds getting **** ready as I get the dog off fluids and to table. Boom some torb. Boom prepped and ready. Boom fluid removed. Only pull 4mls of blood and there's some left, but don't feel too comfy with how it's pocketing and don't attempt another stick. Dog's heart rate instantly drops from 180 to 80. She's suddenly super comfy and lovey. Takes awesome naps except when I wake her up to scan q 2hrs. Call mom three times before 1. Suspected mass seem, though I ain't no cardiologist.

The next morning, I'm on the phone with the owner as the overnight doc comes in. Tell her she can take our cardiologist and at home euthanasia list home after pick up. Day doc is the same as the day before and she's now wondering why the hell I'm talking about death and specialty. So she reads the chart and her face gets the shocked look.

Ultimately suspect homegirl collapsed due to pericardial effusion and that's why she wasnt super stable the whole time. The gall bladder halo is commonly associated with anaphylaxis, but can also be caused by pericardial effusion due to the distention of the portal vein and associated vasculature.

So when doing FAST scans, Fam, check all the cavities!!

As someone who just started doing FAST scans this was a good read.

 

[MixedAnimals77]

Spent a half day at work yesterday (still on maternity leave) but came in for "funsies" just to do a few surgeries. Ended up with a rabbit that was VERY lucky. French lop that the owners caught a rattlesnake in its pen. Owners weren't sure if they shot the rabbit trying to kill the snake or if the rabbit got bit. Rabbit got nailed in the ears-thank goodness for huge floppy lop ears. Owners dropped serious $ on this rabbit they found a year ago. She was doing great this morning. Might end up with messed up ears permanently but craziest thing I've seen in awhile that the o actually proceeded with tx

 

[cdo96]

Had a fun one recently!

gall bladder halo. Overall, suspected anaphylaxis event.

Guys. HOME GIRL HAS PERICARDIAL EFFUSION.


Ultimately suspect homegirl collapsed due to pericardial effusion and that's why she wasnt super stable the whole time. The gall bladder halo is commonly associated with anaphylaxis, but can also be caused by pericardial effusion due to the distention of the portal vein and associated vasculature.

I remember you messaging me about this one and I very helpfully was in the background

 

[battie]

I remember you messaging me about this one and I very helpfully was in the background

View attachment 406371

Trying desperately to not throw the GP under the bus 😅