What to expect when…you have to go to the vet ER
|February 2, 2021
|Posted by Melinda under Uncategorized
Growing up the thought of taking an animal to an ER was unfathomable. The first and only time I’ve had to take an animal to the ER was when I was an adult. Tess got attacked by another household dog as a puppy and her face and mouth was bleeding. She was screaming, I was crying, and for a couple hundred dollars I had some peace of mind, some pain meds, and an antibiotic.
Ironically, now I find myself working in an overnight clinic a couple times a month. It’s just wild. As a *kid, never in a million years did I picture myself in this sort of setting.
*Isn’t life cool? It’s why I roll my eyes when adults grill kids about what they are going to do when they grow up. Who the hell knows?????? Note to self: need to prep my kid with some awesome answers to that question – although I sort of like her answer now: “I want to be a doctor like you, but for people.”
Anywhoo. I’ve been picking up some shifts at a local-ish vet ER and I’m starting to get a feel of the common reasons you might have to pay me a visit in the middle of the night. Here they are off the top of my head, in no particular order:
- The exotic pet that had some sort of trauma 3-5 days ago and now is doing poorly after being “off” since they fell or bonked. And now the owner wants it fixed. They may or may not be wracked with guilt for waiting so long. Sometimes I can help and sometimes I can’t.
- Pocket pets with URI’s
- Vomiting dogs. So many vomiting dogs. Don’t worry. I don’t like vomit either. Vomiting dogs aren’t quite as bad as vomiting cats, but no, I can’t usually tell you on a physical exam why they are vomiting.
- Vomiting and diarrhea puppies you found on craigslist 3 days ago. I suppose this is a subset of #3, but it gets a unique entry since at this point I’m convinced any puppy off of craigslist is parvo positive until proven otherwise.
- The ear infection and nail trim.
- Geriatric dogs that: a) have been “perfectly healthy” up until today and never needed vet treatment, but come in with a list of a gazillion old dog problems and the owner wants to know “what’s causing all this.” b) OR geriatric dog has various well managed health issues that has one specific problem that needs to be checked out. c) OR Geriatric patients that are crashing and burning before my eyes and Jesus ain’t letting go of that wheel this time. Sometimes they are coming in for euthanasia and sometimes they are coming in because the owner needs to hear there is nothing else they can do.
- Trauma. These are the fun ones, don’t judge me. There are apparently some people that get excited over internal medicine cases, which make me want to drive ice picks through my eye sockets. Trauma? YES PLEASE. They range from “I came home to this and I have no idea,” to hit by car, to dog fights (don’t bring your dog over to your friend’s or relatives’ house. Don’t dismiss continually household fighting as “playing rough.”) There’s also broken legs for all sorts of reasons.
- The really weird zebras.
- The dog that ate chocolate.
- The mystery ailment that will go away as soon as you decide to make the drive.
It’s of course very serious and professional when you have to bring Fluffy in at 2am, but if we are just having a theoretical conversation…what is the general, definitely-not-medical-advice of what happens when you come to see me for one of these scenarios?
*Every clinic, doctor, and situation is going to be different. The purpose of this post is not to give medical advice or guide you in specific situations. Rather it is to provide some insight (and entertainment) of what might happen when you need a vet in the middle of the night, and it’s not a horse colicking or doing something else stupid. Also. I really do care. ER pays well but it doesn’t pay well enough for me to pull an all-nighter if I didn’t care about being available to you when you need a clinic in the middle of the night.
First, realize there are levels of emergency clinics. “Vet ER” sounds super fancy, but most nights my clinic is just one doc, a handful of techs, and some not-as-space-age-as-you-would-imagine tools at my disposal. Think of it as an urgent care clinic. If I tell you to go down the street to be seen at the fancy hospital it’s because I think I might have to transfer you there anyways. More staff, more doctors, more specialists, more fancy toys, and open during regular business hours so they can continue to provide care beyond tonight.
Before we start going through what you can expect for the top 10 things I see, let’s talk about the question most owners have for me. “Are you going to have to keep him, doc?”
When trying to make the decision of whether to hospitalize I consider how likely the patient is to suddenly get worse due to its condition and will then need immediate treatment. Is the patient stable? Can pain be controlled through drugs that can be sent home? Is the owner capable of giving the medications and support needed at home?
The bottom line is I will not *recommend anything, including hospitalization, unless I really feel like it will make a difference in the animal’s outcome.
The good news is that most of the cases I see are street-and-treat. The downside is you waited a long time to be seen, and now you are going to wait even longer while we do diagnostics, treatments, and discharge. The upside is that it’s going to save you money.
Let’s get started. We will do the first 5 scenarios in this post, and then follow up post for the rest because my poor little squirrel brain can’t handle the thought of editing a 3,000 word post all in one go.
1: The obvious or not-so-obvious ADR Exotic
For you exotic pet owners out there. Exotics don’t act sick until they are trying to board the boat on the Thames. If there’s a history of trauma, don’t wait it out. Get on top of that sh*t. Also. The chances of you getting an exotic animal specialist in the middle of the night when you finally panic and decide they need to be seen NOW is slim to none. Instead, you will get me.
Now, I’d like to think I’m beyond merely a consolation prize, but an exotic vet I am not. I saw a chinchilla once…in a picture. It’s probably going to be similar to any other small mammal and you bet I’ll have 23 textbooks open and have a phone call into every colleague who does exotics who I have a standing 2am arrangement with….but that’s not really ideal. If you bring me an exotic in the middle of the night, I’m going to treat it for its symptoms in a shotgun approach to cover the bases, tell you the 3 most likely things it is based on 2am research and phone calls, and hope it survives long enough for you to take it to a specialist in the morning. I’m going to be asking a lot of husbandry questions because some of what you are doing is probably wrong and is probably contributing. Exotics are hard. You wanna skip having to be detail oriented about every little thing? Get something resilient like a 12 year old nasty chihuahua that’s going to live forever.
2: The sneezing/sniffling/coughing/snotty pocket pet
Your small mammal pocket pet is sniffling? This I can probably handle. It’s super common, especially if you buy pets at **readily available large retailers.** Depending on the species and how long it has gone on, there’s a good to poor chance we can eliminate it, and an excellent chance it can be managed. Expect fluids, an antibiotic or two, in addition to the exam. An Xray and nutritional support to go home is sometimes recommended depending. (I once diagnosed heart disease in a hamster!!!! I KNOW RIGHT??????).
3: Vomiting Dogs
Think of the vomiting dog like you having a headache. Imagine that the only thing you told me was “I have a headache. Please tell me why.” It’s the cruelest form of torture at 2am. You can probably think of 45 different reasons why you might have a headache. I can think of at least 45 reasons the dog is vomiting. GI related (mechanical obstruction, functional obstruction, HE, enteritis, dietary indiscretion); Endocrine related (Addisons typical or atypical); Neoplasia; Hepatitis; Toxins; Parasites; Inflammation (pancreatitis)…..
Yeah….we can treat the symptoms and provide some supportive care (fluids, anti-nausea drugs, gastro-protectants, bland diet) but there are some causes of vomiting that will resolve on their own with some time and bandaids…and then there’s some causes that will kill your dog.
That’s why usually I’ll suggest xrays (radiographs) and bloodwork. It could be the food it snarfed off the kitchen floor and now Fido’s tummy is upset. It could also be an endocrine disorder or an inflammatory disorder that needs immediate emergency treatment now. Is it OK to treat symptomatically and bring the dog back later for more diagnostics if it isn’t doing well? Maybe. A lot of dogs do improve with conservative treatment. And some are a lot worse off for waiting on getting a specific diagnosis.
Here’s the irritating part. Even if you follow all my recommendations and do diagnostics, there’s no guarantee that we are going to get a diagnosis. But remember, even having information of “it ain’t that” is useful. The diagnostics may tell us “OK to send dog home and try symptomatic treatment,” or they may say “Thank God we caught that because the dog actually didn’t look that bad, but we gotta fix this now.”
In my least favorite cases the patient falls somewhere in the middle. There’s *something* wrong, but it’s a complicated internal medicine thing and an internist I am not. I’ll remind you (and myself) that starting the “detective work” towards finding the answer is a good thing, and in the meantime we will stabilize and treat as best we can. We will get you and your pet through the night or weekend, and then if needed transfer you to somewhere that has the right specialist or the right equipment for further diagnostics so that the detective work can continue. I can’t be all things to all things…. but damn. I want an answer as badly as you do.
4. The craigslist vomiting and diarrhea puppy
Parvo test before you even enter the building.
Because until proven otherwise, that’s what it is.
There’s no cure for parvo by the way, just a vaccine that isn’t fully protective until they are 12-16 weeks of age.
Which means that even if your 8 week old puppy is “up-to-date” on whatever vaccines it supposedly had, it can still get parvo.
If/when your puppy has parvo, you can either hospitilize or go home with a street-and-treat protocol that involves a lot of fluids, antibiotics, anti-nausea medications, and gastro-protectants.
In my experience the survival rate is about the same whether they are hospitilized or not. The ones that are alert and wagging their tails on initial presentation usually make it. The ones that are lethargic and down when I see them don’t.
Stop buying puppy mill puppies. Stop buying puppies off of craigslist. Yeah. I know you’ve had it 3 days and you don’t want to spend $800 treating it when there’s no guarantee it’s going to pull through. When this one dies or we euthanize it, I would suggest not going back to craigslist and getting another one.
OK OK OK…they don’t all have parvo, although some nights it feels like it.
If by some miracle the puppy doesn’t have parvo, it probably has a really high parasite load. Even if your paperwork says it was dewormed multiple times. That is probably going to mean fluids, some anti-nausea medications, a general dewormer, and either a fecal here or ASAP at your regular vet.
5. Emergency ear infection and nail trim
I scoffed at this when I heard this was a thing in ER’s, before I worked in an ER.
It is most definitely a thing.
Especially on a quiet night….I’m happy to take a look. I did GP (General Practice) for long enough and made sure to rotate through Dermatology in my clinical year that ears ain’t no thang (usually. Medicine always has its curve balls). The ear medications at my disposal at an ER clinic is about half that I have at a GP. Good first line meds…but less options than a GP. I might have to make some compromises when I choose a treatment based on availability of what I have on hand.
Here’s the caveat. If it’s not a quiet night, that ear infection with a nail trim is going to wait a long time to get seen. Shrug?
I totally get that you are here because getting into your GP is practically impossible right now. I sympathize. I’m happy to see you….after the respiratory cat, the puppy with a broken leg, and the chicken that is currently trying to die.
You most definitely are going to have to pay for a cytology (sample of the ear contents put on a microscope slide and stained so I can see what shape of bacteria, yeast etc are present). Sure, sometimes in budget cases at the GP I’d occasionally skip the cytology. But that ain’t happening at the ER for a lot of reasons – someone else is doing the follow up on the ear after treatment, not me. And also….if you went to the trouble to come see me and wait five hours because of an ear infection (and bonus nail trim), let’s do it right. You’ve already spent twice as much for the exam as you would have at your regular vet. You are here because you want something done, so let’s make sure it is money well spent!
To be continued…
*If you can’t trust your veterinarian to make recommendations in your animals and your interest, find a different vet. If you can’t afford the recommendation, have an honest conversation with your vet and see whether there is a plan B or C that would work. You may need to sign an AMA (against medical advice) discharge because I need proof that I offered you the “standard of care” medicine and you chose the riskier and usually cheaper plan. Yeah, it sucks but so does being sued and losing your license because one person comes back and says it’s your fault that the dog lost the bet and if they had just known the dog could die, they would of course agreed to treat according to the best medicine. Did you know that I’m personally liable for things performed under my license? In the state of California I’m not allowed to form an LLC or any other sort of business entity that would limit my liability. Protecting my ass (and the quarter million dollar investment I’ve made in this career) and also giving you care options is a tricky, delicate dance.