A Night to Remember

      My two most memorable small animal cases presented during the only night of being on call that I never got to sleep.  The first came at roughly 9:00 p.m.  Our answering service told me that they had received a call from someone whose dog was having a convulsion, also called a seizure.  This is most often due to epilepsy, and the convulsion lasts for only a minute or two.  Usually, when I called the pet owner, I would learn that the convulsion had ended.  At that point, I would explain about epilepsy and ask them to bring the dog in during normal hours for an examination and medication.

     This time was different.  When the owner answered the phone, he explained that his German Shepherd, Barney, was continuing to convulse.  I instructed him to bring the dog to our clinic immediately.  He arrived ten minutes later, and Barney was still convulsing.  I administered general anesthesia, which stopped the seizure.  I started Barney on an intravenous electrolyte drip after drawing blood samples for laboratory analysis.  I admitted him to our clinic for observation awaiting the blood results

By this time, it was 11:00, and I returned home definitely ready for bed.  Before I reached it, the answering service called again, telling me that one of our dairy clients had a cow that needed help delivering her calf.  The drive, delivery, and returning home brought me to 1:30 a.m., now totally exhausted.  Yet once again, before I quite made it into bed, the phone rang. This time it was a horse with colic, so into the truck I went one more time.

     At 3:15 a.m., I was home once again and crawled into bed expecting to get a few hours of sleep prior to starting the next day.  Alas, it was not to be, as I experienced deep despair at the sound of the phone ringing once more.  This time it was a dog that had been hit by a car. Within another twenty minutes, I was back at the clinic, examining a huge Doberman named Lady.  Lady was gasping for breath, and her gums were very pale.  Her abdomen was distended.  Internal bleeding was almost certainly occurring, and immediate surgery was needed.  Her prognosis was grave.

Lady's owner asked that I do everything possible to save her.  I agreed to try and called Dick Kennedy, asking that he come help and bring his large Irish Setter as a blood donor.  He arrived within minutes. Soon after that, we had an IV blood transfusion going into Lady.  She was stabilized for the moment, but still bleeding internally.

     Within another few minutes, Dick and I had her on the surgery table and opened her abdomen.  As expected, it contained a large quantity of blood, coming from a ruptured liver. The liver is a very fragile organ and often damaged when an animal endures physical trauma. The fragility also makes it difficult to repair because the tissue tends to tear when sutures are placed. Imagine trying to sew pieces of meatloaf together, and you get a reasonable image of suturing a liver.  Perhaps Lady's liver was tougher than average because we were able to repair the tear, and the bleeding stopped.  With the aid of the blood transfusion, she came through the surgery okay. I recall being very pleased and, quite honestly somewhat astonished at our success.

     As Dick and I gently placed her in her cage, I looked in at Barney.  He was up and alert. It was now 6:30 a.m. I offered him some food, and he ate it immediately.  I examined him and he seemed normal in every respect.  I still had no idea what had caused the seizure but knew I would have the results of his blood work by later afternoon.  I stopped the IV.

      As usual, we expected clients to begin arriving by 7:00 a.m., so there was no time for a nap.  I did go home for a quick breakfast and hoped this would be a slow day.  That was not to be, as we ended up with a lot of large animal calls and plenty of pet work.  I spent most of the day doing farm calls.

     Around 4:00 p.m., I got back to the clinic and checked on Lady and Barney.  Lady was great.  Barney, however, was exhibiting something I have never seen in a dog before or since.  His teeth were chattering, similar to the way some people’s teeth chatter when they are shivering with cold. But Barney was inside a warm clinic. I checked the blood work and was surprised to see extremely low calcium and extremely high phosphorus.  The values were so far out of the normal range that I called the lab to make sure they had not reversed the two numbers.  They assured me they were correct.

     By now Barney was trembling all over.  I drew another blood sample, and then a light went on in my mind.  The IV fluids I had given him contained calcium.  That explained why he seemed totally normal this morning.  I had stopped the fluids, and now he was once again showing signs of low calcium.  But what was going on to cause the problem in the first place? I had never seen a male animal with low calcium before.

     My next step was to call the University of Pennsylvania Veterinary Hospital and asked to confer with a veterinarian on staff who specialized in canine medicine.  Despite it being almost 5:00, they found the right person in his office, and I explained Barney's case to him.  He immediately knew the diagnosis, which was an underactive parathyroid gland.  The parathyroid gland is a tiny organ, located next to the thyroid gland in the neck.  Among other things, it regulates calcium and phosphorus.  When it is underactive, calcium drops, and phosphorus rises.  This syndrome is very rare in animals and in humans.

     The specialist and I discussed how to proceed, and he suggested I have the owner bring the dog to him for further evaluation and to start treatment.  This was done, and Barney stabilized on supplemental calcium and vitamin D in his diet.  He and Lady both remained patients of our clinic until I eventually left the practice.  It was always gratifying to see either of them.