You would think that in my line of work, especially when I work at the emergency hospital, I save animals’ lives every day (or night). No doubt, all veterinary teams help animals every day. But it is not every day that my team and I treat an animal that is about to die and make it live instead.

Two nights ago a team of nurses and I unequivocally saved a dog’s life*. She was suffocating.

The dog’s owner stated that his mother liked to feed bones to the dog. The family had a barbeque on Sunday. The dog had been working on leftover bones since the barbeque. The owner got home from work on Tuesday evening and found his dog struggling for air. He suspected that his dog was choking on a bone.

When the dog arrived at the emergency hospital she was about to die. She was fighting to breathe. Bloody saliva trailed from her mouth. The nurses administered supplemental oxygen and placed an IV catheter. We immediately sedated the dog (struggling for air causes increased bodily oxygen demand; sedation reduces struggling). I attempted to evaluate the dog’s mouth but handling the area was too painful, even with sedation, for the dog to tolerate.

We administered a surgical anesthetic (propofol) to the dog and I finally got a good look in her mouth and down her throat. The owner was right. There was a foreign object obstructing the dog’s airway. The bone fragment was in the dog’s trachea (windpipe). It was seriously wedged in, and it was big enough to choke a horse. The bone’s diameter was greater than that of the dog’s trachea, and the dog was able to breathe at all only because the fragment had distorted the windpipe into an unusual shape that allowed small amounts of air past the bone’s margins.

The bone fragment somehow had gotten past the larynx (the voice box, which is the opening to the windpipe). The larynx and the back of the throat were horribly swollen.

I experimented with a number of different forceps but they couldn’t grip the bone well enough to extract it through the larynx. Needle nose pliers (I’m not kidding) couldn’t reach the bone. My biggest fear was that I would inadvertently push the bone deeper into the trachea while trying to retrieve it. For a moment I thought that we would have to perform a tracheostomy and to cut through the neck to retrieve the bone.

After what seemed like an eternity (but probably only amounted to a minute or two) I managed to get a good grip on the bone. It was extricated with gentle, constant traction. The imminent crisis was over, but the dog was not out of the woods. Several tiny bone chips and pieces of plant matter were scattered around the back of her throat. These posed a threat. They could be aspirated into the lungs and cause a fatal pneumonia. The larynx was severely swollen. This could compromise breathing later in the night.

We suctioned all of the visible bone fragments from the area and administered steroids and antihistamines to bring down the swelling. Intravenous antibiotic therapy was implemented to guard against pneumonia. The dog spent the next several hours in an oxygen cage. Eventually she breathed well without oxygen supplementation. She went home in the morning.

The nurses who worked with me on this case were every bit as responsible for saving the dog’s life as I was.

Photos: 1) Next time, chew your food. 2) Working. Haven’t even had a chance to start fluids yet. 3) Morning. All’s well that ends well!

Note to veterinarians (and anyone who’s interested): This dog was turned away at closing time from another facility before she came to the emergency hospital. It is amazing that she didn’t die en route. California law states that critical patients must be stabilized prior to transit. This dog clearly was not. What are your thoughts on this?

And let’s take it one step deeper. This dog was a seven-year-old intact Pit Bull whose owner looked like a member of MS-13. Do you think she would have been turned away if she were a one-year-old spayed Lab brought in by a person wearing a suit?

*I concede that the long term survival of the dog is not absolutely guaranteed. See notes in post.

Truth really can be stranger than fiction. The other night I treated two animals in succession for precisely opposite problems. The first was starving. The second was at risk of serious complications from gluttony.

An animal control officer brought a starving cat to the hospital at about 10:00 pm. The cat’s owner had been found dead in her apartment earlier that night. The police estimated that the elderly woman had passed away from natural causes two weeks before she was found. According to the animal control officer the cat had eaten nothing in those 14 days except–I swear I am not making this up–its owner’s eyeballs.

The cat was very sweet, very dehydrated, and very emaciated. We administered IV fluids and offered easily digestible food.

While I was evaluating the unfortunate cat, another patient arrived. His name was Louie. He was a one-year-old Golden Retriever. Like the cat, he was very sweet. Unlike the cat, he was far from starving.

Louie had been visiting a friend’s house. The friend had a dog. The friend’s dog’s food was kept in a large bin. Louie had broken into the bin and eaten his fill. Or rather, much more than his fill.

Louie was suffering from a syndrome called food bloat (not to be confused with gastric dilatation and volvulus, also simply known as bloat). Food bloat is common in humans on Thanksgiving. It is common in Beagles, Labrador Retrievers, and Golden Retrievers any time they have unfettered access to large quantities of food.

An X-ray of Louie’s abdomen revealed that his stomach was massively distended with food. He had taken his gluttony much further than the average American does on Thanksgiving. He had consumed at least 10 pounds of kibble. He had trouble standing and walking.

Louie also received intravenous fluids. But we certainly didn’t feed him! He was hospitalized overnight for monitoring and frequent walks to encourage him to defecate.

Fortunately, both cases ended well. But they definitely illustrate a feature of emergency medicine: you never know what will come through the door next.

Photo: Louie could seriously harm himself at this market in Turkey.

The client stated that the dog was twitching and behaving abnormally. That meant he needed to come in.

When the dog arrived it was clear that he was under the effects of caffeine. He was agitated and vocal. He trembled continuously (this isn’t exactly abnormal for a Fox Terrier at a veterinary office, but in this case the tremors were extreme). He was jittery and cranky. Clearly he wasn’t a regular coffee drinker–he couldn’t hold his caffeine very well at all.

A brief chat with the owners revealed that coffee ground logs are eco-friendly (and canine-unfriendly) fireplace logs. They consist of used, dried coffee grounds pressed together in the shape of a log.

The owners were not sure how much of the log the dog had consumed. None of us had any idea how much caffeine was in the log. However, high doses of caffeine can cause seizures, heart palpitations, and death in dogs.

We decided to induce emesis (in other words, to make the dog throw up). An intravenous injection of “old reliable”, aka apomorphine, was administered.

The dog began to vomit. First came some undigested kibble with a few coffee grounds. Then came pure coffee grounds. Then more coffee grounds. Then more, and more, and more.

The Fox Terrier had eaten enough coffee to kill a Mastiff. Fortunately, his vomiting got it out of his system. We kept him overnight to monitor for further symptoms. None occurred. He is now back to his normal life in his newly free-of-coffee-ground-logs home.

But now I know, and I’m warning you, that coffee ground logs are hazardous to pets.

Photo: “Honey, have you seen the coffee?”

A fever often is a sign infection. Infected fight wounds are the number one cause of fevers in outdoor cats. But this cat was kept indoors and had not escaped. Why was his temperature so high?

The owner decided to volunteer additional information. She had noticed that he was reluctant to walk and jump. He didn’t wan’t to raise his tail to “wink at her”. It seemed to her that his “butt” might be sore. And at one point she noticed that one of his “butt cheeks” seemed larger than the other. She suspected that one of his “butt glands” might need to be “squeezed”.

I evaluated the cat’s hind end. It seemed symmetrical to me. However, cats have notoriously hairy butt cheeks and it was hard to see through the fur. The owner allowed me to perform a Brazilian trim on her cat.

Once the hair was out of the way, it was clear that the area to the left of the cat’s anus was swollen. A rectal exam revealed that the left anal gland was infected and infiltrated with pus. I drained the pus and the fever broke within an hour.

Fortunately the client did not ask to be present when I lanced her cat’s anal gland abscess. She surely would have regretted it.

Photo: here’s looking at you, kid.

A gentleman brought his two-year-old Poodle to the emergency clinic where I work Sunday afternoons. The Poodle ate a sock two days ago. No symptoms were observed for 36 hours. However, this morning the owner noticed that the dog was lethargic and reluctant to play. He seemed uncomfortable and had vomited twice.

The background was consistent with a bowel obstruction secondary to a gastrointestinal foreign body. In this case, the suspected foreign body was a sock.

When a dog or cat (or rarely, human) eats something that is too large to pass through the intestines, it causes a life-threatening obstruction of the intestinal tract. Surgery usually is necessary to retrieve the offending object. I started bracing the owner for the possibility that his dog might require emergency surgery. The dog would need to be hospitalized for several days, and I would have to work far too late to write a blog post.

The dog was very nervous. He became scared and tried to bite me when I approached. He also had diarrhea–that is common in extremely frightened animals. The owner was unable to place a muzzle on his pet for the exam.

I truly needed to examine the dog. Without an exam, I could not be sure that it would be safe to administer tranquilizers for treatments and X-rays. I had no intention of doing anything aggressive or invasive to the dog. I simply needed to listen to his heart and lungs, and to palpate his abdomen gently.

A staff member helped with the exam. As I listened to the dog’s heart the frightened canine passed more diarrhea, then a solid bowel movement, and then more diarrhea.

That was most extraordinary. It is not normal for a solid bowel movement to be sandwiched between two episodes of diarrhea.

I asked a nurse to save the solid stool. She evaluated it with a tongue depressor and discovered that it contained a yellow and green striped sock.

Problem solved. The anxiety of going to the doctor evidently increased the dog’s intestinal motility. This evidently dislodged the sock and caused it to pass.

As I write this the dog is now happily at home. And so am I.

Photo: not edible. And frankly, not very stylish either. By Rico Shen.

The cat had been diagnosed with feline lower urinary tract disease, or FLUTD. The syndrome causes pain and inappropriate urination. In male cats it can lead to a serious complication called urinary obstruction. Cats with this syndrome are unable to urinate. If cats with urinary obstructions don’t receive prompt treatment they die in agonizing fashion.

The special diet I recommended is designed to reduce the symptoms of FLUTD and to decrease the risk of urinary obstruction.

The cat’s owner, however, thought I had ulterior motives for recommending the food. He accused me of wanting him to buy an expensive food for no reason, so that I would make more money.

The accusation would be risible if it weren’t so offensive. I was terribly bothered that the man thought I would put money above my patient’s well being. The man also evidently thought that I am stupid. That offended me too.

If I were interested in nothing but money, and if I didn’t care about my patient’s well being, and if I were at peace with the idea of going to hell, then the intelligent thing would be to recommend against a special diet.

That way the cat would suffer with the syndrome until he developed urinary obstruction. Treating urinary obstruction is a big deal. After blood tests, IV fluids, anesthesia for urinary catheter placement, and intensive inpatient care for 2 – 5 days the cat probably would be ready to leave the hospital. The bill would be well over a thousand dollars–perhaps much more.

There is plenty of profit in urinary obstruction. Selling cat food is chump change. When I recommend a special diet for a patient with FLUTD, I am putting the cat’s well being above my own profits.

If I truly cared about money I would have become a consultant or a CEO. Because it is not possible to be money grubbing, intelligent, and a veterinarian at the same time.

Photo: Pennies, folks. Not twenties. Not hundreds. Pennies.

A thorough general physical examination was unremarkable (unremarkable is how veterinarians say normal–we can’t actually say normal because the word normal, according to some malpractice insurance providers, implies things that can be very dangerous if we have missed something subtle).

The symptoms were consistent with an anal gland problem. If you never have heard of anal glands, consider yourself lucky. You may want to stop reading now in order to preserve your innocence.

The anal glands are bulbs located adjacent to the anus. The bulbs are connected to the anus by ducts. The glands produce a fluid with a unique odor. It smells like a combination of rotting fish, feces, and tear gas.

Cats and dogs have anal glands. Skunks do too–the glands are modified in skunks and are responsible for skunks’ unique smell.

The anal glands normally empty when a cat or dog defecates. In some instances, however, this does not happen as it should. The result is anal glands that are impacted and distended. Animals with impacted anal glands often drag their rear ends along the ground.

Impacted anal glands are treated by manual expression. The most effective means of manually expressing anal glands involves inserting a finger into the animal’s rectum and massaging the accumulated fluid out of the glands.

This is what I proposed for my patient whose hind end was so uncomfortable.

The owner accepted my proposal. However, she declined to accept my recommendation that the procedure be performed in a section of the hospital where only employees were present. She asked to be present while her dog’s anal glands were expressed.

Palpation of the glands revealed that they were both markedly distended. Both glands were expressed with ease. A large amount of fluid was released.

As the smell of the fluid filled the room, the owner of the Miniature Schnauzer soon was ill at ease. She complained of light headedness and dizziness. She asked to sit down. She retched and nearly vomited.

The nurse and I escorted her to some fresh air. She rapidly recovered. I blame myself for not warning her vehemently enough that anal gland fluid smells really bad.

After enough time one becomes inured to the smell of anal glands. To the uninitiated, however, it can be overpowering.

Friday was Cody’s second birthday and on that night the family threw him a birthday party. Twenty-five people attended. Many of them were children. All of them brought gifts for Cody. Most of the gifts were edible.

During the party Cody received and immediately devoured several rawhides, pig’s ears, and sundry other dog treats. He also took the opportunity to hoover up any human food that was dropped during the party. His owner mentioned that one partygoer accidentally dropped an entire hamburger on the floor. Cody wolfed it down as the crowd sang Happy Birthday.

As the owner recounted this story I thought to myself that this massive amount of dietary indiscretion sounded like a good way for a dog to contract pancreatitis. Pancreatitis is a life-threatening inflammation of an organ (the pancreas) that is involved in the digestion of food. I began to get worried about Cody.

The owner’s story continued. The party ended uneventfully and everyone went to bed. The next morning (Saturday) Cody woke up feeling awful. He could barely move. He had no appetite (which, the owner assured me, was most extraordinary for Cody).

The owner was not very worried initially. But by Sunday afternoon Cody’s condition still had not improved. He refused to eat, and he still was extremely lethargic. He therefore wound up in my office.

When I examined Cody I was troubled. He was very lethargic. His abdomen was bloated and painful. He was extremely dehydrated. I recommended hospitalization and tests to rule out a serious problem such as pancreatitis or a foreign object (such as an undigested fragment of food) in his intestines.

Cody seemed to feel better after he was re-hydrated. And I was happy to see his test results. He tested negative for pancreatitis and other serious metabolic disturbances. His X-rays were not consistent with a foreign object in his intestinal tract.

However, the X-rays did show a very large amount of food in Cody’s stomach. This was most extraordinary in a dog who hadn’t eaten for two days. And it led to a diagnosis in the case–the best possible diagnosis considering the circumstances. Cody appeared to be suffering from a resolving case of glutton’s remorse (term coined by my friend Reading Maley).

Canine glutton’s remorse occurs when a dog overeats in the extreme. The stomach becomes massively and painfully distended, and the dog feels markedly ill for several days as the food slowly passes out of the stomach and through the intestines. The condition is painful and rarely triggers a life-threatening condition called bloat. However, most young dogs make it through episodes of glutton’s remorse unscathed. In my experience the condition is most common in Labs and Beagles (remember that Cody is a Lab/Beagle cross).

The nursing staff administered an enema to Cody in order to help keep everything moving through his system. I expect him to make a complete recovery. And I imagine that he never again will party as hard as he did on Friday night.

Photo: Feed me. Please. By Mzelle Laure.

Of course, in this case the dog was not at all to blame. His owners, on the other hand, could use a healthy injection of common sense.

The dog was a young, active large individual. He liked to run. The owners were more sedentary in nature. Recognizing that their pet needed exercise, they took him to a quiet road and set him free. They then followed behind in their car.

They followed too closely. The dog became tired and slowed down. Can you guess what happened next?

Fortunately, although the dog was injured when his owners struck him with the car, the injuries were not life-threatening. Pain killers, antibiotics, wound care, and nasal oxygen support were all that he needed.

But I am amazed that his owners failed to foresee the likely consequences of their way of exercising the dog. I worry about that dog’s future.

Photo: Blix demonstrates safe dog-car interaction. His risk of injury is minimal.

As I walked to the checkout line I thought to myself that there were enough plants in the display to kill half of the dogs and cats in San Francisco.

Sago palms are beautiful and common house plants. Sadly, few people realize that they are deadly.

Every part of the common sago palm is toxic. The plants are palatable to cats and dogs. Both may suffer liver failure after ingesting the plant. Remarkably few people realize this, and countless loving pet owners unknowingly place their animals at risk by keeping these attractive plants in their homes or gardens.

Today I saw a cat who was in serious trouble. He was in the prime of life. He was an indoor-only cat. He appeared to be in perfect health. Unfortunately, his face was covered in lily pollen. A conversation with the owner confirmed my worst fears. The cat had chewed on stargazer lilies.

Stargazer lilies are staples of many bouquets. They are beautiful. They also are deadly. Cats especially are at risk. Lilies, especially stargazer lilies, may cause irreversible kidney failure in pets.

If you have pets, please don’t allow these two deadly beauties into your house. Nothing good can come of it.