Diagnostic Workup Success – that almost wasn’t.

MollyThis is Molly.  A few days ago she was presented for an examination.  She had been limping a little the night before and just didn't feel well.

There was no lameness when she came in, but she didn't have much mojo.  She didn't seem in any distress really, just no energy.  She also had not wanted to eat much.  There was no fever, nothing seemed swollen or out of place, and I couldn't find a sore spot anywhere.

She lives in a fenced yard, so trauma didn't seem likely, even though she shares it with another pretty big dog.   There just wasn't really anything to put your finger on, but you could tell she was unhappy.

I was about to send her home with some anti-inflammatory medicine, thinking she might have slipped and made a bad landing in the mud the night before.  Then her owner said, "You know she usually chews on everything, but she doesn't want anything today."  I asked, "Everything, as in a lot of things that aren't food?"  She replied in the affirmative.

With that piece of information, I thought of all the dogs with foreign body intestinal blockages I have seen who had no specific outward signs — they just didn't feel good. "Let's take an X-ray of that belly. We probably won't see anything, but I'd hate to miss a ridiculously obvious foreign object."  Okay, let's do it.

The abdominal X-ray looked normal, but there was a little bit of the chest on the film, too.  When I looked at the whole film, the chest part looked "funny" (funny-strange, not funny-haha).  We took pictures of the chest.

There was what appeared to be a significant amount of fluid in the chest.  That will make you feel bad.  We tapped her chest – it was blood.  Internal bleeding will also make you feel bad.  In your chest, it will squish your lungs and eventually keep you from breathing, even if you don't go into shock first.

Even though there was no history of exposure to rat-poison, we filled her full of vitamin-K (the antidote).  That stuff makes the dog a free bleeder, and bleeding into the chest (hemothorax) is not uncommon.  Since my associate is pretty knowledgeable in Chinese medicine, we also started the herbal preparation called Yunnan Baiyao, as it helps to get the body's own clotting mechanisms into high gear.

The alternatives to rat-poison were not happy ones: a bleeding tumor, some other abnormal structure that had begun to bleed, or some other heretofore unnoticed bleeding disorder in the dog.  All of those have a terrible prognosis, not to mention that referral to a surgical specialist was not in the cards.

Thankfully, Molly has responded well to treatment and seems about normal now.   Who takes a full set of X-rays every time a patient just "doesn't feel good"?  Nobody.  A chance remark, a look at the wrong place, and we got an accidental look at the right place.  And I almost sent her home with some pain-killers.  Serendipity, it's called.

2 thoughts on “Diagnostic Workup Success – that almost wasn’t.

  1. Kathleen says:

    How do you suppose she got into rat poison?

    So glad you were able to figure out what was wrong with her. And, I bet her people feel the same.

  2. Doc says:

    She does stay at more than one house, and she does go for a walk sometimes. Dogs are a lot closer to the ground than people are, and a lot more interested in eating goofy stuff.

    The anti-coagulant type poisons are slow-acting, and it is generally several days after ingestion before the dog becomes ill.

    The up-side is that if you see them eat it, you have plenty of time to start the antidote. The down-side is that they look okay at first, so sometimes people just assume that they didn’t get enough to hurt them. Three or four days later the dog is bleeding to death.

    The source of exposure is not known here, and our diagnosis is really based on response to therapy. If the dog is just getting better in spite of us (as mysteriously as she became ill), I’m okay with that, too. More worrisome though.

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