Friday, November 19, 2010

Wag More...Bark Less...

Have you ever had a bleeding nose?Or if you want to sound cool and knowledgeable; have you ever suffered from Epistaxis?

Well I can assure you that it is extremely swallow your own blood, messs up your clothes and your nose becomes kinda sensitive to touch and your stools!!!Lool!

When I first saw him, Rocky was sitting quietly between a couple in their late 60s and observing everything very carefully in the waiting room. Beautiful mongrel with definitely some Dachshund blood, as evidenced by his short and slightly "twisted" front legs. So I finish my cat surgeries and get Rocky on the exam table to start the routine subjective data collection i.e. owners' story of the case. As soon as I asked the first questions, the lady started one of these long monologues where it is sometimes totally off the doggy case. I learnt about Rocky's Epistaxis problem but also about her daily schedule, about her stained rug, about her nosy neighbours, about how the other vet talked to them badly about how her husband did not help and all her despair about Rocky sneezing blood everywhere in the house!

Oh Well...So doggy is bleeding from the nose huh? Dog was very cooperative and I had no problem working on my "rule-outs":
Rule Out 1: Trauma to the nose. Trauma bleeds are mostly unilateral and this was a bilateral case. Nasal bones intact but inside mucosa of nose very swollen and red
Rule Out 2: Foreign body in nose. Nothing exciting palpated nor seen from inside nose!
Rule Out 3: Maxillary fistula from decayed tooth (usually canines). Dirty tarred teeth but all looked ok and no bumps felt on gums that would indicate abscess or anything. Gums paperwhite and even without any blood test I could see that this dog was very anaemic and that this bleeding has been going on for quite some time.
Rule Out 4: Nasal Tumour. Swelling precluded any further investigations.

So turned back to the owners and asked what did the other vet prescribe.
Antibiotics...Vincristine...and Dycinone.Antibiotics, no harm in giving some; Vincristine - too cytotoxic to my liking to start giving when you did not even confirm any tumour and Dycinone is ok to stop the bleeding. We often forget that when we lose blood we not only lose the red blood cells but also fluid and the volume of circulating goes drastically down. The animal's spleen holds some blood in reserve but that was visibly not be enough for Rocky. In such states animals collapse after minimal effort due to improper irrigation of essential organs...namely the brain! So I get the IV drip line flowing with Dextrose 5% (am sure Rocky won't mind some energy boost)and start telling the owners that they should keep the animal on Dycinone tablets and get some high-iron liver extract to enhance blood cells production.

OMG...the lady started telling me how impossible it is to give medication; how the animal does not eat; how she thinks the dog would die all of a sudden after sneezing all his blood. I barely had a time to place a word...I was trying....seriously trying!The old man who had remained silent all the time was trying to help me and asking his wife to wait and listen and all. Then he just snapped and screamed " Why don't you just shut the F**k up and listen to the Doc!!!" (To ca'av ferme to la guel et ecout dokter la?" People! World War 3 just started in Island Vet Clinic! Poor doggy sitting in the middle of all this, drip running and eyes big! After an uneasy minute, I intervened and told them that this is of no help to the dog and they'd better calm down.

Remember, the "pack-theory"? A dog considers all the members of your family as individuals of his pack; and behaviour in packs is highly ritualised. So your dog will observe and interpret all the signs from your body language, tone of voice and...from the smell that emanates from you. Fear has a smell...Anger has a smell...Despair has a smell...and your dog senses all this. Picture this now: Rocky sits there in severe anaemic distress, nose bleeding and assisting to a riot amongst the other members of the clan...not quite appeasing huh? In times of distress, your dog expects some extra care and support...not flooding his senses with Adrenaline and surely not dropping the ball on helping him fight the disease. Never forget that you are in a pack with him.

One other thing that you must never forget: Your dog will only be in the vet's hands for 30 mins for exams injections etc...the rest of the 23 hrs 30 mins of the day he will be with you and you have to follow up with the care at home. So many people tend to think that bringing animals to the vet is enough...UUH! NO! The bigger role is yours!Especially in feeding the animal properly. No food= No energy=Weak Defenses=Worsening of Disease.
The mechanic can fix the engine; change the tyres; redo the paint...but if you do not put fuel in your car it won't move.
By the time I finished explaining all that to the old couple,Rocky was done with his drip session and I sent them all with the "take-home" note: I you want to be of any help to Rocky, think like a dog and act as the leaders of the pack; and do not bail out on him at the first difficulty and...try to bark less in front of him...wag more please! (of course this last part was not said to them ! Loool!)
Pfffff....that was one of these moments! But life comes with nice surprises next patient was a fiersty yellow parrot!

But that is another blog in itself...

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