960887?1283485836
Jon Geller, D.V.M.,, Dipl ABVP  
Male
Ft. Collins, CO

Specialties: Canine and Feline Medicine

Interests: Urgent Care, Emergency care, critical care
Veterinary Emergency Hospital
970 484-8080
Ft. Collins, CO
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In The ER: If it looks like a duck...

Jan 19, 2010 - 2 comments

154079?1264462156

“Are you sure Dozer did not swallow any dog toys or clothing,?” I asked.
“No, we keep the yard cleaned up so there is nothing for the dogs to get into,” replied Dozer’s owners. Thus began the search for the cause of vomiting in this 8 year- old Alaskan Malamute.
There are at least 63 causes of vomiting in dogs, which is probably why we see so many cases at our emergency hospital. Sometimes we need to do diagnostic tests such as X-Rays and blood tests to start narrowing down the list, if the cause is not apparent after a thorough physical exam and history-taking. A few dogs need an even more sophisticated level of diagnostic workup, such as an adrenal gland function test or abdominal ultrasound.
At 8 years old, it seemed unlikely that “dietary indiscretion” would be a likely cause of Dozer’s gastrointestinal problems. Much higher on the list were conditions such as cancer, immune-system disease, pancreatitis, liver failure or kidney failure.
Dozer seemed uncomfortable and somewhat tense when I palpated his abdomen, but did not appear overtly painful. “Let’s do some radiographs to see what things look like,” I suggested. (My X-Ray vision was not up to par that day.)
When the digital images appeared on the screen, the nurses could tell something was abnormal. We all gathered around to throw our two cents in. Dozer’s intestines were very distended with gas in certain areas. There was a strange density in the cranial (toward the head) part of his abdomen. We kept looking.
In one of my finest moments of X-Ray reading history, I suddenly saw it: “It’s a rubber ducky!” I almost hollered. Squinting at the images and moving closer, we asked each other, “How (and why)  does a dog swallow a rubber ducky whole?”
Two hours of surgery later, the naughty duck sat like a proud trophy outside Dozer’s run. It was somewhat blackened after the journey through his intestines, but probably was still quite capable of floating if required. The owners explained, “It used to be Dozer’s favorite toy. He probably buried it months or years ago. He may have been mad at us for leaving him behind for a few days when we went out of town last week, and decided to dig it up and swallow it to get back at us.”  Would a dog do that?




In the ER: Coffee, anyone?

Dec 02, 2009 - 7 comments


          We used to have sign in our lobby that said “Any unsupervised children will get a cup of espresso and a free puppy.” We took it down after one of the clients asked what kind of puppy we were giving away.  We now have self-serve coffee in the lobby anyway, and it’s not uncommon to see a kid trying to short-circuit the coffee maker.
          Which brings us to the case of Tonsi, a 7 yr old, hyperactive Australian Shepherd who tore into the 50 pound sack of coffee beans his mom brought back from Nicaragua. Fortunately, he was discovered before he devoured the entire sack (which certainly would have resulted in his demise), but he did manage to scarf down several pounds.
           Our staff has the routine down for toxin ingestion cases: an injection of apomorphine  to cause vomiting (it always works), then some charcoal to absorb any toxin from the intestines, then possibly IV fluids for 12-24 hours, depending on the ingested substance. To be honest, these indiscriminaate dogs seem to keep our ER’s in business. Tonsi vomited up a large amount of undigested coffee beans soon after getting his apomorphine, but apparently there was a lot more caffeine on board, as we were soon to find out.
          Tonsi’s heart continued to race at 180-200 beats per minute (normal should be around 80-90.)  He was amped up and wired to the gills, jumping straight up in superman-like attempts to leap over the 8’ high run walls in a single bound. He gave all of us the jitters; it was almost as if Starbucks had spiked our water. I have to admit, equally enthused and irritated by Tonsi, I had been imbibing more than my share of coffee during the shift.
          One of our nurses suggested giving Tonsi a beta-blocker, which would help slow down his heart, but we did not have any stocked on the shelves. At this opportune time, enter (stage left,) Corky, a 6 yr old Cockapoo who had just ingested his owner’s vial of medication, which included, (guess what), a beta blocker.
          One more dose of apomorphine, and I found myself sifting through the vomitus. I spotted a small red tablet, perhaps the ingested beta-blocker?  Tonsi continued to wildly leap  in his run, barking crazily. As I slid the red tablet out of the bilious slime with a tongue depressor, an idea crept into my over-caffeinated, somewhat deranged mind; do I dare?



In the ER: A Unicorn's Journey

Nov 03, 2009 - 3 comments

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Frank loved to eat things. As a stout one-year old Lab, eating is what he lived for. Living with a family that included 6 yr old quadruplets supplied him with plenty of objects of his desire. His family reported finding lost clothing, toys and other random items in his stool.  Frank avoided any serious issues with his indiscriminate eating habits until one night last month, when Frank decided to swallow a Beanie Baby unicorn, whole.
After vomiting for 24 hours, and losing his famous appetite, Frank’s owners knew something was wrong. X-Rays at our emergency hospital showed a strange bulge in his intestine, with a triangular object encircling it. Large pockets of gas upstream from the blockage confirmed that he had a surgical problem, and off to surgery he went.
Our emergency veterinarians opened a piece of Frank’s intestines up, and  found the Beanie Baby unicorn without even a tooth mark on it. Frank must have wolfed it down as if it was a cocktail mini-hot dog. Wrapped around the unicorn, perhaps substituting for a piece of bacon, was a rubber band, which is what showed up as a triangle on the XRays.
Frank had about a foot of devitalized intestines removed, and then the remaining ends were sutured back together, and he was closed up. The next day, as Frank recovered from his surgery, we discussed strategies for preventing future recurrences.
“ How about a cage muzzle?” I suggested, and the owner agreed it would be a good idea, considering the chaos that usually ruled at his house. With five children running around with the Frankster, the availability of a pair of stray socks, underwear or even another Beanie Baby, was inevitable. Frank went home the next day with his owner, the intact Beanie Baby cutely enclosed in a plastic baggie, perhaps destined to be displayed on the fireplace mantle.
We did not expect to see Frank back at our hospital, but one week later he was sick again. He was lethargic and not eating, and one look into his eyes would tell you he was not feeling well. He was clearly, please excuse the expression, “sick as a dog.” Repeat X-Rays were suspicious for another blockage, and ultrasound confirmed it the next day. Frank went back to surgery at his regular veterinarian’s clinic, where a large wad of impacted grass, as well as more intestine, was removed. Apparently, he had been grazing in the yard, despite the cage muzzle.
Hopefully, we have seen the last of Frank. He doesn’t have much in the way of intestines to spare. Every time a dog undergoes repeat surgery, adhesions can form on the surface of their intestines, causing them to stick together. Any previous surgery site can shrink down into a stricture, creating the risk of future blockages. Frank’s family will have to be diligent about keeping his cage muzzle on, and ensure that all he eats is dog food. This should help guarantee that the family’s remaining Beanie Bay collection remains intact. Maybe Frank’s owners could sell it to cover some veterinary bills.




In the ER: Ernie's Reprieve

Sep 29, 2009 - 3 comments
Tags:

cats

,

hypothermia





On a frosty November morning, three large dogs took off across a field after an orange barn cat named Ernie. Too far from the safety of the barn loft to return, Ernie scampered down toward a nearby ditch, which was running full of icy Colorado runoff. Trapped at waters edge as the pack approached, Ernie plunged into the frigid waters, but the dogs followed. The three of them surrounded Ernie in the ditch, biting at his body and shaking it in turn, as Ernie desperately struggled to get free.
A neighbor spotted the fracas from their kitchen window, and rushed outside to run the dogs off. Ernie struggled to claw his way out of the ditch, using only his front legs to scrabble onto dry ground. There he collapsed, barely moving.
The cat I saw that was rushed into the treatment room of our emergency hospital appeared to be dead.. Barely breathing, frigid to the touch and hair coat soaked to the bone, he felt like a cold, wet rag. “How old is he?” I asked, surprised to find out he was only five. With his sunken eyes and battered face, he appeared to be closer to 15.  
Ernie’s body temperature did not register on our thermometer, but probably was close to 85 degrees. Our nurses rushed to warm him up and treat him for shock. A surgical air warmer blew hot air into a blanket under his body. Warm bags of IV fluids were packed around his torso. An IV pump pushed another bag of warm saline into a catheter in his front legs. An IV drip of pain killer and antibiotics was started.
Four hours later, Ernie’s body temperature finally registered at 92 degrees F., still 10 degrees below normal. He finally raised his head and slowly looked around, as if saying to himself, “I’m still alive?” He may have considered himself in kitty heaven with  warming air blanket and fluid bottles, along with the doting attention of the veterinary nurses.
Although Ernie had minimal use of his back legs, he gently kneaded his front toes when he was scratched along his back. At this point, I sensed he was going to be OK, despite his apparent rear leg paralysis and the large bite wound in his flank.
By the next morning, Ernie could walk, he was eating, and, although he was moving very slowly, he was ready to go home. With some TLC, pain meds and antibiotics, he would enjoy a week at home before returning to his mouse-hunting haunts in the barn.
In considering Ernie’s astounding recovery from the attack of three dogs in a freezing ditch of water, I suspect that the icy cold water created a hypothermic response that was protective. As his body systems slowed down, to a semi-hibernation state, blood flow to critical organs like his kidney and brain was preserved. Eventually, as he warmed up, his heart was gradually able to restore his circulation,  giving him back use of his rear legs.  
Cats like Ernie continue to amaze me at their ability to survive the most dire of circumstances. As veterinarians, we can provide the basic supportive care, but it is grit and tenacity, mostly, that carries these tough felines through.