The joys of On Call
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 
Tetanus
This first post about a case is going to be kind of “exciting” as tetanus in pets is very, very rare. Tetanus in Horses is very common, mainly due to the fact they sustain injuries so readily and also live in the environment where the bacteria (Clostridium tetani) grows (soil mainly). Its extremely rare for dogs and even rarer for cats to get tetanus as they appear to have a high resistance to the tetanus toxin and can take 3-4 weeks sometimes to begin showing clinical signs. It is more common in horses to get generalised tetanus – ie the whole body is involved, whereas in cats/dogs, they can get localised tetanus, usually around where the contaminated wound is. Cats and dogs can still, however, get generalised tetanus, but this is rarer still
This case was a 2 1/2 month old American Bull Dog. The family who owned it were lovely and did everything by the book (kept at home, only allowed into well enclosed back garden until both vaccines given etc). I saw the dog on a Friday afternoon. All he presented with was raised 3rd eyelids and slightly off colour. Nothing found on clinical exam, everything completely normal apart from a slightly high temperature. He was given some antibiotics in case a brewing infection of some origin (suspected gastroenteritis as he was eating things in the garden). Saturday the dog was apparently fine, back to normal, running around with the kids, then, Sunday morning, the dog was flat out and unable to stand. Our practice was on call that weekend so my boss saw the client in question. The dog presented stiff, mentally aware, could move legs and head and tail but just couldn’t move to stand up. Boss man suggested likely differential diagnosis such as ingestion of neurotoxin, genetic defect, meningitis or tetanus and gave him sedatives and muscle relaxants. I then took over on call and the case in question.
Typical "concerned" facial expression due to contracted facial muscles
At the time he was mentally very aware, would wah his tail when you spoke to him but any loud noises/touching him would send him into increased muscle spasms. His body was shaped like a typical tetanic “rocking horse”, a shape known as opisthotonus. He was, at this stage, able to lift up his head and lap from a bowl so we could feed him liquid food and water. Repeat sedative and muscle relaxants like Diazepam were given intravenously but Diazepam has a very short duration in dogs and we didn’t have the Midazolam that we needed to put him on a constant rate infusion to stop the muscle spasms.
Opisthotonus
Monday morning he had deteriorated and the opisthotonus had increased, he was now unable to lift or move his head at all and was very distressed. Diazepam only worked for a short while and then the spasming would start up again. Money was an issue for the family and this was a total unexpected shock for them. If the animal deteriorated any further (as can happen with tetanus as the respiratory muscle spasm.seize up and they can go into respiratory arrest) referral would be on the cards to a Veterinary School/hospital with the necessary drugs and equipment to put him on a ventilator. The thing is, with Tetanus, if you have enough time and money, some cases can pull through as the nerve endings unbind eventually from the tetanus toxin and normal muscle movement is regained. The owners decided, partially for monetary reasons and the fact they couldn’t bear to see him so distressed, to put him to sleep A sad ending to a very rare and unfortunate case
First post….quite scary
I have no idea how this blog is going to pan out. A few users on a Glasgow based internet forum have mentioned that the stories and tales I have from work are fairly interesting and would possibly do well on a Blog of some sort. Good idea, think I, but where on earth do I start? A quick root around and WordPress was the site I chose to start my Vetblog on.
About me, well, I have to keep things here fairly secret due to not wanting to reveal clients names or their animals to the world. I will change names, not reveal where I work or my actual name, but the associated stories will be the same. I will post the occasional picture to show interesting and sometimes rare things that I have seen but wont name names or anything like that to keep things confidential. Basically, I am a fairly recent Veterinary Graduate (BVMS 2006). I am originally from Scotland but had to move down to England for work. Most of my friends and, indeed, my lovely boyfriend are in Glasgow, and I am still looking for a job up in Scotland to bring me nearer to them. I’ve been in this job for a year and a half now and every day new cases are popping up that totally stretch my knowledge. I have seen the weirdest cases in the last week than I have since i’ve worked here!
What I hope to achieve here is to show cases I have seen, what we found, what we did and just basically inform people of the many weird and crazy things that can happen to their animals and hopefully, how we can fix them. There are loads of people with access to the internet that come into work with completely wrong information as they try to self diagnose so I aim to help people a little bit more with the most common things we see, rare things we see, when to worry and when to not worry.
I hope I have explained things well here! If there is enough interest, I may also write a few posts such as what happens when my dog/cat gets neutered? When to Vaccinate/worm/flea treat etc. I may write similar informative posts of that ilk as well as discuss various hot animal topics such as one of my favourites – the banning of tail docking in dogs.
Hope you find this Blog fairly interesting! The day to day life of a young vet can be crazy busy, specially as on call can be where the maddest things can happen! Any suggestions for topics/questions etc i am happy to receive and answer 
