Let it Snow...Let it Snow...Let it Snow...

We got another snow storm here last night...and it was pretty slow at the clinic as a result. I did see a couple cases...one I admitted was a referral from another veterinary clinic...8yo MN Rhodesian Ridgeback who presented to explosive bloody diarrhea. On PE he was severely dehydrated with tachy mucous membranes but nice and pink and normal capillary refill time (push on gums and count how long it takes for the pink color to return...normal is 1-2seconds...this can give an indication of perfusion...so if they are shocky and need fluids it would be prolonged)...his was normal...rectal revealed frank blood, he splinted on abdominal palpation (was extremely painful)..remainder of exam was WNL (within normal limits). Admitted him, ran coagulation times, CBC, electryolyes (rDVM had done a chemstry that was normal) - bloodwork came back fairly normal - except PCV/TS were elevated (54/8.0), he had a L shift (immature white blood cells high), and his cPLI (canine pancreatic lipase - test for pancreatitis) was abnormal...however pancreatitis was not the first thing on my list although it could definitely be a factor as well. I was thinking more HGE (hemorrhagic gastroenteritis) - this is basically a disease where the dogs are really dehydrated, they have elevated PCV/TS, and usually are having blow-out bloody diarrhea and sometimes vomiting as well. We did abdominal ultrasound and it showed gas in stomach and intestines and decreased motility but not real other abnormalities. So I started him on rehydration rate of fluids, metronidazole (anti-diarrheal antibiotic), unasyn (another antibiotic - because of the L shift), cisapride (for intestinal motility), and fentanyl CRI for pain control. Also placed a nasogastric tube and started trickle feed of Resorb for enteral nutrition (gut nutrients to keep it from sloughing even more...keeps gut cells happy!!). He has fecal cultures pending that I submitted to check for other fecal pathogens (salmonella, campylobacter, clostridia, shigella). We will see how he does...hopefully he does well. My second case was an old hunting lab who had pain somewhere that the owner couldn't fine where...PE was fairly normal, normal neurological examination, but severe pain on dorsoflexion and L lateral flexion of the neck. Sedated, did cervical radiographs, didn't see nothing, placed him on strict cage rest, no neck leads, tramadol, and rimadyl (NSAID). I think it is just muscle pain in him because neuro was normal and the owner mentioned that the shock collar he has on for the invisible fence was malfunctioning so I think the dog got repeatedly shocked and has muscle trauma due to that...poor dog!! My next case was a pitbull who came in for a red eye....now there are about 8 causes of red eye (glaucoma, scleritis, episcleritis, keratitis, conjunctivitis, trauma...)...So I do PE - aside from the R eye (OD), normal PE. I sedated dog and then did my fundic exam (to look at retina, optic nerve), this was normal. I then checked pressures (tonometry) and they were normal (13mmHg). I then stained the eye with FES and checked for a corneal ulcer - there was none. When I was examining the globe however, there was a lot of scleral hemorrhage and bruising on the globe - looks like a traumatic, blunt hit type injury. So I prescribe steroid drops for 3-5 days (because there is no ulcer) and then when I take dog out to owner he mentions that earlier he had to tackle the dog when they were walking so the eye was probably bumped at that time. Poor dog, but should heal up just fine. My last case was a 2yo MN orange (!!!!) cat who was straining in the litter box. He came back as a stat because of possible urinary obstruction...but I palpated bladder and it was very small, soft. So I talked to owners about different causes of FLUTD (feline lower urinary tract disease)...urethral obstruction (which he still could be in the early stages of), UTI, stones, idiopathic cystitis....discussed running bloodwork, urinary ultrasound, and urinalysis....owner agreed....everything came out fairly normal...did prescribe a couple days of pain meds and antibiotics in case of infection....but he probably is one of the idiopathic cystitis cats (meaning we don't know what causes it but something causes them to get bladder irritation and they end up with these straining episodes) Discussed management as being increased water consumption and pain medications....talked about switching diets to canned urinary diet because he did have crystals on the urinalysis. He went home...but he was a really cool cat...talked and loved to be held....And that was my night. Now I am heading back in for day 2/5. It is Friday so I am sure tonight will be busier as all the regular veterinary clinics transfer their disasters over to us for the weekend. But, I am happy because after this 5 day shift I am finally on the ICU shift for basically the rest of my time here....happy times coming off the floor..yay....actually get to manage cases!!!! Alright....I have to head out to work.