Posts Tagged ‘Conditions and Diseases’

She was back again. Sweetness was a thirteen-year-old collie dying from chronic interstitial nephritis. Each time the Watkins family brought her in, I thought her long struggle was over.

Mr. Watkins carried her in, struggling despite the fact she had been shedding pounds off her originally much too plump frame for the past several months. Mrs. Watkins was trying to comfort their thirteen-year-old daughter Emily.

“She only lasted six days this time Doc,” Mr. Watkins announced.

I glanced at Sweetness’ chart. “I see that.”

I was treating the dog with intravenous fluids to flush her body of the metabolic toxins that accumulated because her kidneys were no longer functioning properly. The first time I treated her she lasted for almost a month with a special diet and fresh clean water always available. She drank a lot, urinated a lot and with restricted activity seemed to do pretty well. The next time I treated her she lasted a little over two weeks, the third time was six days ago.

“Can’t you do something else?” sobbed Emily. “This isn’t working she’s so weak and just sleeps all the time and won’t play with me.”

“There must be more you can do Doc,” Mr. Watkins insisted. “You know cost is not a problem for us.”

I glanced out the front window at their barely operational car. I also knew the neighborhood they lived in and the state of disrepair of their home.

“We can try peritoneal lavage that might work. I can smell the urea on her breath, she’s very toxic. Actually, she needs kidney dialysis and a kidney transplant but neither are available for dogs. Most people who need those treatments can’t get them.” It was 1963.

“Do what you can Doctor,” Mrs. Watkins chimed in. “We’re not ready to give up on her you know she and Emily were babies together.”

“OK, leave her with me and I’ll see what I can do.”

After they left, I reviewed my veterinary school notes on peritoneal lavage and started the treatment. Sweetness encouraged my efforts with a single-thump of her tail on the treatment table. I finished infusing the dialysis solution I mixed up and started drawing it off. Two hours later, I removed all the fluid I could retrieve and she seemed slightly improved. She rolled up on her sternum and gave my hand a lick. I took some blood to check her kidney function again and found it was only slightly improved. I put in an intravenous drip and decided to see if I could flush her out again. Over the next several hours she seemed to improve, then regress. I couldn’t leave but couldn’t think of anything more to do, so I just maintained a vigil and kept the intravenous fluids running. At three in the morning, she took a final breath.

Still wondering what more I could possibly have done I called the Watkins home to tell them Sweetness had passed. Without saying anything about my diligence, I wanted them to know I gone the extra mile with her.

“OK Doctor,” said Mr. Watkins. I could hear Emily crying. “I’m certain you did all you know how to do.”

“That’s true, what do you want to do with her body?”

“We anticipated this, we’ll send someone. How much is the bill?”

I felt guilty about Sweetness dying, not knowing what more I could have done.

“Uh, let’s see,” I had spent at least eight hours working on the dog and used over a hundred dollars of drugs and supplies.

“I think a hundred and fifty will cover it.” I felt guilty about charging so much.

“Uh, just a minute, I added wrong, a hundred will do it.”

“OK Doc, I’ll get a check to you in a month or so.”

The next morning a man drove up to the clinic in a Nash Rambler. A sign on the driver’s side door advertized “Paradise Pet Cemetery”. He opened the back, took out a cart then took out a polished wood casket and placed it on the cart.

“I’m here for Sweetness Watkins,” he announced.

“Follow me,” I said. “That’s a very nice casket, just curious, how much is this costing the Watkins?”

“Four hundred and fifty, plus perpetual care, paid in advance,” he smiled. “Mind if I leave some business cards with you for future clients?”

That was the last time I felt guilty about legitimate fees.

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Epistaxis (bleeding from the nose) is more common in dogs than in cats, in my experience, probably because most cats are indoor pets these days. It can occur from one or both nostrils and can vary from slight bleeding that usually stops without treatment to profuse, possibly life threatening bleeding, that resists treatment. As with most abnormal conditions your pet may suffer, proper treatment depends upon establishing the cause.

Some incidents start with sneezing and traces of blood in the discharge from the nose while others can start with alarming, and profuse, bleeding. Any cause of persistent and/or violent sneezing can result in a nosebleed. The most common cause is a foreign body such as a foxtail, grass seed (awns), a small blade of grass or a burr. Other causes of sneezing are nasal infections from bacterial and/or fungal organisms and, of course, allergies that initiate sneezing episodes. In rare cases, the infection from a rotten tooth can extend into a nasal sinus and/or the nasal cavity and cause bleeding. Of course, trauma to the head or nose can result in a bleed and cancers of the nasal cavity, particularly hemangiosarcoma, frequently invade the nasal cavity and result in persistent bleeding.

Less common causes include problems with blood clotting that can result from hemophilia or von Willebrand’s disease (a specific type of hemophilia) and hypertension (high blood pressure). The ingestion of warfarin-based rodent poisons, either directly or after eating a rodent poisoned by one of these agents, can be a cause, as well as systemic infections that involve the blood (septicemia) or bone marrow. The bacteria that responsible for Rocky Mountain Spotted Fever and Ehrlichiosis can cause epistaxis. Other infectious causes include the feline leukemia virus (FeLV) or feline immunodeficiency virus (FIV) in cats. Very ill animals can develop disseminated intravascular coagulation (DIC) with nosebleeds, as can animals with immune-mediated thrombocytopenia. The use of some drugs including methimazole (a drug used to treat animals with a hyperthyroid condition), estrogens, sulfa drugs and some chemotherapeutic treatments for cancer can cause bleeding as well.

If your pet has a nosebleed first try to keep it calm, then hold an ice pack on top of the muzzle. If the bleeding stops then returns, or does not stop, take it to your veterinarian. Do not treat your pet with aspirin or non-steroidal anti-inflammatory agents (NSAIDs). Tell your vet if the animal has been on any kind of medication, been exposed to rat poison or other pesticides, dead rodents, or to a place where s/he could have sniffed up a grass awn or other seed head. You must tell your vet if your pet has been roughhousing with other animals, sustained a trauma to the head or face, been sneezing or rubbing at the nose, had blood in the mouth or gums, a black tarry stool or had “coffee-ground” vomiting. Any of these signs could help with the diagnosis.

After a thorough physical exam, your veterinarian may need to examine the nasal cavities with a small endoscope, do blood work, radiographs, nasal swab cultures and antibiotic sensitivity tests and/or fungal cultures and possibly allergy testing. In cases of neoplasia (cancer), a CT or MRI scan may be necessary. The good news is that most nosebleeds are not serious and once the cause is determined and removed the nosebleed will no longer be a problem.

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