Piglet's Day in the Pet ER
Monday. Yesterday I spent my morning with a Piglet (that’s his real name). He’s not really porcine, just a pudgy little four-year-old Yorkie with a vivacious personality—but not on this Sunday morning.
I had seen him the day before during regular office hours for what we in the vet profession call ADR (as in, he ain`t doin` right, doc). Poor Piglet had a low-grade fever (103) and a slightly elevated white blood cell count (usually indicates infection, often a bacterial one). His belly was a little uncomfortable (but he’s had back issues and that makes it difficult to tell if back or abdomen is really the culprit).
To make matters worse, Piglet was either coughing of throwing up occasionally, his owners couldn’t really tell. He had been in a boarding kennel recently so an airborne disease (like kennel cough) was possible. Piglet coughed easily enough for me when I felt his trachea—but the kid’s got a sensitive trachea anyway (Yorkies often have what’s known as a collapsing trachea that makes it sensitive to compression).
So let’s recap our problem list: coughing, gagging or vomiting, low-grade fever, possibly ouchy belly and/or back, and a mild increase in his white blood cells.
Fluids, antibiotics, good nursing care…that’s all he seems to need for the moment. He gets it. His parents take him home with a promise to watch him 24/7 and call me on my mobile if his condition takes a dive.
Piglet’s no better on Sunday morning. His temp is the same, but with most infections, the antibiotics I set him up with should have dispensed with any fever by this time. No deal. He’s more tense—painful? His chest sounds clear (wheezy upper respiratory sounds but no fluid or dull spots) and his belly seems more sensitive. More fluids. Add another antibiotic. I can’t take X-rays or run more tests on a Sunday, but call me throughout the day with updates and we’ll do these tomorrow.
A couple of hours later he seems much worse. Meet me at the hospital. A temp of 104 in spite of antibiotic therapy is a huge red flag, of course. His breathing is harder, as is his abdomen. Meet you at the emergency hospital for some X-rays and follow-up bloodwork. Let’s get to the bottom of this thing and keep him hospitalized on fluids.
Even after the tests, Piglet keeps us guessing. Is that pneumonia (his chest X-rays are definitely not normal) or is that a mass in there? We see lots of gas in the stomach and intestines. Is that inflammation or just the consequence of ingesting air while panting up a storm?
Piglet spent his Sunday in the oxygen cage receiving IV fluids. He’ll be transferred to the surgery service at 8 AM today. His fever’s still there after 48 hours on antibiotics and fluids. No good.
It’s clear that Piglet decided not to read the book on this one. Hopefully, he’ll abide by his namesake and eventually pull out of his difficulty by allowing others to take the lead. Remember, it’s Pooh that always makes all the big decisions.
Pooh will be ultrasounding him today if he continues this way. I’ll keep you posted.