Toxicity overload

So today started off seemingly quiet. One appointment was booked in and and one procedure was scheduled for the day.  This procedure was a simple dental descaling on a lab. Not too bad of a day. Nice and easy, with a couple of appointments scheduled for the afternoon run. 
I walked in the door to find one patient referred from afterhours. A cat who had trouble urinating the night before. Eldery neutered male. You would expect perhaps a blocked urethra, however, his bladder was small and soft. 
After discussion with his owner we elected monitoring and urinalysis if he were to urinate. The owner was not overly keen on advanced diagnostics. So we decided to treat symptomatically and see how we go. Which was slightly difficult as he was presenting unusually, however without full diagnostics, we could not know definitively what was going on.
Once his dripline was reestablished and I was happy with how he was, I set about preparing for the one appointment that was scheduled. Which was a nice easy on.

Before that consult was due to come in the phone started ringing.The receptionist picks it up and is informed that the caller's dog has eaten chocolate. Upon hearing this we advised that they come down immediately as he had apparently eaten large amounts of dark chocolate. The darker it is the more toxic it is to dogs.
Not even 2 seconds after the receptionist had put down the phone, it began to ring again. Another toxicity case. This dog had gotten into possum bait - brodifacoum (an anticoagulant) to precise.Again we advised that they come in immediately. 
While we were waiting for the two toxicity cases to come in, one of our long time favourite patients owner called in. The dog had been feeling rather flat yesterday and today and she (the owner) was worried. She is a special girl and due to being on so many medications we had her in as soon as possible.
So flat girl came in and was triaged by the nurse - she was able to wait and wasn't in any discomfort nor was immediately concerning. Possum bait dog walked in the door immediately after Flat girl. Possumbait was a golden labrador; a breed renowned for eating anything and everything.
I took Possumbait through with her family and immediately gave her medication to vomit. Possumbait wasn't overly keen on vomiting straight away, so we waited there holding kitty litter trays lined with newspaper in an attempt to catch any vomitus that decided to eventually come out.
While I was waiting for Possumbait to vomit, the chocolate toxicity dog came in and was dropped off by his owners. I left Possumbait in the exam room with her family to examine ChocTox. He was also a golden lab! Two golden labs with toxicity in the same day!! I immediately administered the vomiting medication to him as well.
I went back to check on Possumbait; there was no vomit yet. It seemed to be taking a while. I really wanted it to work, as I didn't want to have to anaesthetise her and flush out her stomach if I could help it. She was looking uncomfortable and was starting to drool, which showed the drug was having an effect, however it did not seem to be enough, so I had to give the poor girl another dose. This particular medication is a little pill that is inserted in behind the eyelid. It is immediately broken down and absorbed via the mucous membranes of the eye. Due to it's ability to be easily absorbed, one must wear gloves, unless one feels like risking wiping one's eye or mouth and inducing some vomiting in oneself. Upon mixing with tears it produces a green discolouration. So I had two golden labs, with two green gooey looking eyes.
While I was dealing with Choctox I heard a disgusting squelching sound come from the consult room. "Yes!" I exclaimed inside my head, Possumbait had vomited. I quickly trotted back into the room to be greeted with two kitty litter trays (and some of the floor) filled with green vomitus, comprised of dog biscuits and chunks of bait. 
Excellent, she had vomited. I flushed her eye out and applied an eye ointment to lessen the irritation from the medication. I left her in the room to see if she would vomit any more.
Choctox had not yet vomited, so while i was waiting for him to do so I moved out to the reception area to examine Flatdog. Flatdog was lying there, alert, but disinterested in her surroundings. On examination all her vitals were normal, she was just feeling flat. So luckily I was able to treat her and she was able to go on her way. However while I was treating her another client came in for an arthritis injection to be given to his dog. At this time I had all three available rooms filled with a sick dog plus/minus vomitus, so really had nowhere to go! Luckily my amazing nurse was able to do the injection for me while i attended to the others.
I went back to the treratment area where Choctox was to find he had finally vomited! Yay!. He vomited, not only chocolate, but the wrappers as well. A familiar shade of orange packaging showed he had ingested an entire packet of Rheeses pieces amongst others.
His green eye was flushed out and treated.
Next came the messy bit. Both dogs required activated charcoal. Activated charcoal is given in toxicity ingestion cases as it absorbs and binds to toxins remaining in the gastrointestinal tract, preventing them from being absorbed systemically.
I had to make up a slurry of activated charcoal for each lab and administer it orally with a syringe.
Sure, this doesn't sound complicated, however activated charcoal gets everywhere, and stays there. It's worse than glitter, and it is the blackest black you can imagine. Well, try giving this to a patient that had just been made to vomit and doesn't want to eat your nasty gritty slurry. There is often a lot of head shaking, and spitting it back out, so you, the floor, the wall, the patient and the nurse get covered in blackness. The little towel that you put down underneath the dog is not enough to do the job, but you pray and hope that this time you will be lucky.
Once this was done, both dogs were reassessed. And appropriate treatment was given. Possumbait dog will need to be on Vitamin K for the next 3-4 weeks to prevent her from haemorrhaging as brodificoum is an anticoagulant that works by interfering with clotting pathways. The vitamin K helps to prevent that. She will be back in next week to have her clotting factors assessed.
Choctox, was very lucky, we had gotten to him fast enough that he hadn't developed any signs of seizures or arrythmias. We were able to detoxify him safely and send him home with his owners.

Once these guys were dealt with I was able to do my dental procedure on another lab (a black one this time) and get out to lunch! Woo lunch. I was even able to have a little nap.
Afternoon consults, weren't overly exciting. I had a little itchy dog that tried to eat my hand off, luckily he didn't succeed and I still had my hand. The owner was wonderful though and knew he could be a bit titchy (it happens when you get old and sore).
Apart from that it wasn't so bad.
Vet medicine certainly shows you that you don't know what could come in the door next. Just because the appointments might be sparse, doesn't mean you won't be busy.
I felt rather proud of myself today though and shouted myself Burgerking. :)

I still have blackstuff in my nails. :(

A quiet day

In vet medicine and probably many other fields, the word "quiet" is a swear word. If you start to even mention it in the veterinary clinic you will either be shushed before you can finish the word or you will be given a dirty look.
However in my quiet day today I did many things. I vaccinated a few dogs and gave them worm tablets. I pulled a grass seed out of a dog's foot, I clipped up a cat's sore bitten elbow and treated his swollen right carpus which resulted from a cat bite. I initiated treatment on a dog I had diagnosed with demodectic mange. I repeated antibiotics on a severely dyspnoeic dog. I gave several patients arthritis medication via injection. I treated a baby sparrow for nystagmus and I treated a wild bird for a cat bite. I saw a miniature schnauzer with self trauma and pododermatitis.

This was a quiet day! However I did so much! Make sure to appreciate your vet!

This is my little cat attack guy. I have a figure of 8 bandage around his wing. I have no idea what kind of bird he is though. Which is unusual for me!