It has taken me almost two whole weeks but I have finally recovered from my horrifying Sunday on emergency call. Not only did I have to attend to 3 seizuring dogs, 2 pony colics, a dog stitch up and two strays.. but also had to drag my poor husband in ON HIS BIRTHDAY to monitor two patients while I was out treating one of the ponies.
After that horrible Sunday, I had a great weekend at Sydney as we got to properly celebrate my belated husband’s birthday.
One of the emergency calls I received on that black Sunday was ‘Nellie’, an 8 year old Border Collie cross, that the owner thought was walking a ‘bit funny’ in her back legs. The owner thought that she was lame on one or both her hind legs. Given the dog’s age, I recommended she bring her in.
As soon as Nellie walked in around 11ish a.m., I knew she was suffering from some type of poisoning.
All her muscles were twitching, she was walking like a drunk and any noise would make her jump out of her skin. I immediately put in an IV catheter in her leg and gave her a dose of muscle relaxant to prevent her twitching from escalating into a seizure.
During that time, I was also busy interrogating her owner about any poisons the dog could have had access to like snail pellets or insecticide spray or an overdose with flea control treatment. When I uttered the words snail pellets, the owner’s face went pale and I had my answer. She immediately called her husband to make sure the other dog they had in custody (one they were looking after) was not clinical.
Unfortunately, ‘Nellie’s twitching started to get worse and she was almost starting to convulse.
I had topped her up with several doses of muscle relaxant and they weren’t doing anything. I explained to the owner that if I can’t get the twitching under control, I will need to put ‘Nellie’ under full anaesthetic and perform a gastric lavage (stomache pump) and enema to get rid of any undigested snail pellets in her gastrointestinal tract. I offered to call a vet nurse in so the owner can go home but she refused as she knew every minute mattered and we had to act fast. She was more than happy to assist me in whatever had to be done.
I proceeded with giving ‘Nellie’ alfaxalone, an induction agent intravenously and passed an endotracheal tube down her throat and hooked her up to an anaesthetic machine. Even under full anaesthetic, ‘Nellie’ continued to twitch and was about to start seizuring. I gave her another dose of muscle relaxant while she was under anaesthetic and her twitching finally hit a halt! I then passed a stomach tube down her throat and we started to perform a gastric lavage. We got a small amount of green snail pellets out but after a while, we weren’t getting anything so I filled up her stomach with activated charcoal. Activated charcoal is meant to neutralise snail pellet poisoning.
We then performed an enema and we didn’t yield much there. After ‘Nellie’ experienced a full gastric lavage and enema while under full anaesthetic for over 2 hours, it was time to wake her up. I warned the owner that this was the moment of truth; Nellie may still wake up and start to twitch and if we can’t control those symptoms with muscle relaxants, she will need to be put back under full anaesthetic for a much longer period and her prognosis for recovery would become fairly guarded.
The prolonged anaesthetic had lead ‘Nellie’ to develop hypothermia.
To help her recover from her anaesthetic, we had to offer her excessive supportive therapy to warm her up. This included placing her on a heat matt, covering her with heaps of blankets and surrounding her with hot water bottles. Expectedly, her owner was quite anxious during this period. Every time ‘Nellie’ made a move, her owner would look at me and ask if that was normal.
As ‘Nellie’ started to warm up, she was starting to wake up and shiver a little bit. Many pets shiver when they recover from an anaesthetic and it can be due to a combination of things: hypothermia, confusion or even pain. However, in this particular case, I was watching her like a hawk and trying to make sure that her shaking wasn’t progressing to any form of seizure activity.
It was actually quite hard identifying if ‘Nellie’ was deteriorating into a hyper excitable state. We had to hold our guns and be patient and allow her to fully recover from the anaesthetic. After 1.5 hours, ‘Nellie’ progressed to howling and she appeared quite confused and distressed. She couldn’t get comfortable even in the owner’s presence. While the owner was distressed with ‘Nellie’s vocalisation, I was actually happy to see her conscious and free of any seizure activity.
Just as I thought things were looking really bright for her, ‘Nellie’ started to vomit.
Nellie’ brought up a lot of activated charcoal. We also discovered her vomitus contained snail pellets wedged in grass. We had to fish all that material out of her mouth and prevent her from swallowing or inhaling them. I was informed that ‘Nellie’ was big on eating lots of grass.
That information suddenly dawned on me as it explained why the stomach tube kept getting clogged up and didn’t facilitate much lavage. This also meant that ‘Nellie’ may still have a stomach full of snail pellets which will only lead her to develop symptoms of poisoning. A horrible possibility suddenly popped in my head: ‘
The snail pellets were wedged in a web of fibrous plant material and the only way to get them out would be surgically!
During that perplexing revelation, I decided to hold onto my seat and not make any rash decisions. I had to monitor the patient closely and my next treatment step would be tailored to what develops. ‘Nellie’ continued to vomit and brought up heaps of snail pellets that we kept clearing from her mouth, throat and bedding. She was starting to get sick of us opening her mouth and shifting her around.
Fortunately, she didn’t develop any recurrent symptoms of snail pellet poisoning. However, she did manage to inhale some charcoal into her lungs in spite of all our efforts at averting that situation. At that stage, ‘Nellie’ developed sporadic coughing episodes and she actually coughed up charcoal on a few occasions. I immediately started her on antibiotics to prevent her from contracting an aspiration pneumonia.
By 6 p.m., ‘Nellie’ was bright and alert and had stopped vomiting but she still had a persistent cough.
I was simply inundated with so many emergency calls that night and so I felt that ‘Nellie’ would be monitored best at home by her owners. I thoroughly discussed home care instructions with ‘Nellie’s owner and sent her home with her IV catheter still in place. The owner was aware that if any twitching episodes returned, she was to call me and bring ‘Nellie’ straight back into my care.
At 11 p.m., I was called out to my second pony with colic. I finally got home at around 1ish a.m. and still hadn’t heard back from ‘Nellie’s owners. The saying ‘No news is good news’ kept echoing in my head.
Just before I went to bed, I started to reflect on the course of my day and was quite astounded with ‘Nellie’s owner. She really stepped up to the plate when it came to the crunch time. She did not bail on her dog during her time of need. Not only was she playing an excellent vet assistant and witnessing many gory parts of my job but also maintained her cool while her own dog was under full anaesthetic. She remained quite focused on all the tasks I had given her throughout the ordeal from monitoring ‘Nellie’s breathing to filling up the syringe with activated charcoal and so forth. Personally, I don’t think I could have even managed to maintain my cool if my own dog was in ‘Nellie’s shoes. During the whole process, ‘Nellie’s owner kept confessing her absolute remorse for her poor judgement in not cleaning up the snail pellets that were spilled in the shed.
‘Nellie’s owner and I forged an excellent team in treating a critical patient and this illustrated that a veterinarian and client working together can make a world of difference for the patient involved!
I booked ‘Nellie’ in for a revisit the next morning. She arrived full of beans and happy as ever. I took her IV catheter out, loaded her with yummy liver treats and sent her on her merry way. She went home with a 14 day course of antibiotics to treat her aspiration pneumonia and she made a full recovery.
This is ‘Nellie’ the day after her poisoning. Looking at her, would you be able to tell what she had been through 12 hours ago?
- Poison is poison (rayyathevet.com)