On Call.  The two words to strike fear into any UK vets heart.  Until recently, I didn’t have to do on call.  Sadly, that changed.  Due to laws and what the RCVS says, all Veterinary practices in the UK must have an out of hours emergency service in place.  This is rather hard in far to reach places in the highlands etc but in main conurbations, is quite easy to do.  Some places have a special out of hours (OOH) practice/veterinary hospital in the area (within half an hour of their own practice by law) that they can suscribe to and therefore all their clients can go there.  Other places have a few practices that club together and make up an on call rota between them.  The former is what we used to do, the latter is what we now do.

Any Vet that says they enjoy on call is lying.  Usually.  Most of the phone calls you get are from people who just want advice about silly things, then dont take it, or people with real problems, but cant afford the call out fee, so they usually wait til things get really bad then come in, or the actual genuine emergiencies.

My first day on call was not too bad, a few small simple things then went to bed early.  Got awoken rather rudely by the dreaded ring of my on call mobile at 2:30am.  Someones dog had collapsed, I discussed through but the owner was hysterical.  Met her at 3am at the practice.  Her dog was bright but quiet, its mucous membranes were white as a sheet and her tummy was big.  Abdominocentesis sample (put a needle into her tummy) revealed free blood in her abdomen.  This was bad.  There are only a few things that cause an older dog to collapse (here are a few, I am sure there are many more but these are a few I have come across)

• Arthritis
• Fibrocartilagenous embolism
• acute cardiac failure
• ischaemic attack (like a doggy stroke)
• Idiopathic Vestibular disease
• ruptured tumour in abdomen

I suspected this doggy had the latter.  This is, surprisingly, quite a common thing we do see.  Sometimes the dog is too far gone and we have to put them to sleep.  The tumour is usually quite a malignant one called “haemangiosarcoma”.  Basically it makes new blood vessels but wrongly and usually occurs on the spleen of liver (or, sometimes, on the heart).  It can grow away happily for months, and then, because it is a delicate and friable thing, can rupture and the dog can bleed out into its tummy.  Some dogs die instantly, some go a bit off colour but the tumour clots and stops bleeding (but will prob bleed again in the future), and other present as “collapsed”.

I discussed the case through with the owner (money was an issue) but she wanted us to do anything that we could to save her dog.  The dog was prepped, Xrays taken (which confirmed the presence of a lobulated mass in the cranial abdomen), IV fluids were started and then we knocked her out and proceeded with an exploratory laparotomy.  Exlaps usually fill me with dread sometimes if I am unsure of what i am going to find, but in this case I went into cool cucumber mode as I kenw what I was going to find.  A large ruptured tumour was founf on the cranial pole of the spleen with a fist sized clot next to it and a smaller non-ruptured tomour on the caudal pole of the spleen.

Ruptured tumour to R of picture, unruptured one to L

The abdomen was full of blood but no other organs were affected.  At 4am I did my first ever splenectomy!  Everything went well, the dog came round well and went back to the owners own vets the next day.  As far as I am aware she is still alive.  Histology confirmed the presence of a haemangiosarcoma.  This is a highly malignant tumour and even with a splenectomy, it usually recurrs 3-6 months later, probably in the liver so the long term outlook for this doggy is not so good