But I Swear She’s Sick!

Posted: Feb 1, 2016
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The rumors are true. In a momentary (that seems to have lasted a few weeks) lapse of judgement I made and followed through on the decision to add a puppy to my life. Losing Phoebe so quickly and without warning was quite shocking and although I had a busy few months of travel and lecturing, my house felt way too quiet and empty. Hurley, my cat, did a wonderful job trying to fill the void; he greeted me at the door, followed me around, and begged for food but his talents end at evening walks around the neighborhood and hikes in the woods. I needed a dog. I knew when I was migrating over to Petfinder every time I was online that it was time to start seriously thinking about new dog.

Thankfully the universe knows all and supplies what’s needed. A friend’s parent’s landscaper had a German Shorthair that was secretly pregnant before they got her and they suddenly found themselves with 7 extra dogs. They lived in the San Francisco Bay Area, but I just happened to have a vacation planned there the very week that these puppies turned 8 weeks old. Thank you, universe. All it took was a decision on a dog (based, of course, solely on looks), a pet plane ticket, and a plan for the meet and greet/puppy exchange. It went off without a hitch and the week of Thanksgiving I had a dog again. Elliot (the girl) was beginning her journey to fill the dog hole in my life.

She is a really good puppy. I know this because Phoebe was not a really good puppy. Elliot has taken to house training, leash walking, toy playing, car travel, and office working without too much complaint. She is happy, social, loves people and dogs, and if she’d just stop chasing the poor cats life would be pretty close to perfect. But, because she is a puppy, sometimes things end up in her mouth that shouldn’t be there. Like the Saturday morning when she found a bottle of Afrin and chewed it apart, ingesting an unknown quantity of it. In case you didn’t know, oxymetazoline when ingested by dogs causes vomiting, bradycardia, pale mucous membranes, lethargy, electrolyte abnormalities, and potentially tremors and seizures. I didn’t notice anything was amiss until large quantities of vomit were deposited in multiple places in the house. After a quick search of her area I located the bottle and a google search led me to the symptoms to monitor. She was certainly quiet, had vomited, and my previously exuberant puppy now had white and tacky mucous membranes and a heart rate of 58bpm.

Now to the point of this rambling story. I hesitated for a moment, confident enough in my nursing skills that I could monitor her and rush her in To DoveLewis if she worsened. But then my real brain took over and told me that I didn’t need to wait until she was collapsed and having seizures, just bring her in, give some fluids and monitor her lytes and ECG. Into DoveLewis we went, got triaged, and had some admitting vitals taken. TEXTBOOK normal. Everything was perfect. Heart rate 110, blood pressure 120, gums pink, happy happy puppy. Blood work was also perfectly normal. Little maropitant SQ and we were on our way to find something else to chew on.

I felt a little silly rushing my happy puppy into the ER with complaints of white gums and bradycardia only to find out the magical healing powers of a 15 minute car ride. Don’t get me wrong, I was pleased to go back home with a healthy puppy, but it got me thinking about all of the seemingly normal, or “not that sick” patients that we may see.  I have certainly been guilty over the years of rolling my eyes at the transient limping, the complaints of lethargy, the vomited one time patients that I triage in the ER. These non-emergent cases are taking staff time and energy when we have REAL emergencies we should be focused on! But not every case ends up like Elliot. Once the mild lethargy turned out to be pericardial effusion. Once the limping turned out to be a pathological fracture from osteosarcoma. Even if it turns out that the patient really is completely normal, don’t dismiss that owner concern. Encourage it! Believe their story when they say the animal was acting terrible at home and tell them it’s a good thing they came in for an exam. If we dismiss that owner instinct we may just encourage ‘wait and see’ and the next time that dog comes in it will be collapsed and having seizures.

Triaging over the phone is a difficult skill and a challenge, and we don’t want the reputation of just telling everyone to come in without question, but trust the gut instinct of those owners, and don’t fall into the trap of not supporting that concern when arrive with what appears to be a perfectly healthy pet. Elliot has been to the ER three times in the ten weeks we’ve been together – she promises to bring me many blog topics in the future. Stay tuned…