UT-VMC emergency room tails: Pickles

UTVMC COLUMN HEADER  2By Dr. Amanda Rainey

It can be challenging to treat a friend or family member’s pet, especially in an emergency situation. As veterinarians we want to help every patient, but when we have a personal attachment to the owner there is an added desire to do all we can to fix things. I experienced this situation on a recent hot Wednesday evening.

We had several cases that we were working with through the UT-VMC ER Service when our specialty ER intern pulled me aside. We have known each other since I first moved to Knoxville as a new graduate and have celebrated holidays and the birth of his two daughters over the years of our friendship.

He wore a concerned look on his normally relaxed, jovial face and quietly told me that his wife was on her way in with their cat. The cat’s name was Pickles and his wife had discovered her having breathing trouble. Pickles had been diagnosed with suspected feline asthma several months ago, but had never really experienced any true distress, just sporadic coughing fits.

I prepared our oxygen cage and gathered some supplies in anticipation. My stomach was in a knot and I felt nervous with many thoughts swirling through my mind about what could be going on and what we should do to treat her. Within minutes we received the overhead page that Pickles had arrived. She was immediately rushed to the ICU.

My worst fears were confirmed when I saw just how severe her breathing difficulties were. The small calico cat was panting too fast to count the rate of respiration and saliva hung in streams from her petite mouth, her eyes wide and frightened. Her tongue was blue. I knew we had to act quickly or risk losing her. Our ER intern gazed at me with tears in his eyes and quickly stepped out to be with his family while we went to work. Pickles was one of two cats at their home, but was by far the most social and the best with their young daughters.

Respiratory distress is always a scary emergency. It is a delicate balance between treating the patient and not causing them further stress by manipulating them too much. One has to provide care in stages, often giving a single medication or performing part of the physical exam and then placing them back in oxygen in between.

We administered several puffs of albuterol, a bronchodilator, to attempt to open Pickles’ airway. Over the course of the next half hour we also gave her an injection of steroids and another airway medication called Terbutaline. The most difficult part was waiting to see if she would respond. My quick physical exam had revealed very harsh lung sounds, but no evidence of heart disease, which is always a differential when encountering a cat or dog with sudden breathing difficulties. I hoped desperately that I was treating the right condition.

To everyone’s relief, Pickles began to breath normally within an hour of her arrival. We were able to begin her on an overnight treatment plan for asthma.

My heart felt infinitely lighter to see her behaving like a normal cat in the oxygen cage. After her stabilization, I suddenly felt overwhelmingly tired but thankful that we were able to pull her through. Our ER intern returned to the ICU about the time Pickles began improving. We shared a grateful hug that solidified the fact that she was going to survive.

(Dr. Amanda Rainey, DVM, is a clinical assistant professor in the small animal clinical sciences department at the University of Tennessee Veterinary Medical Center in Knoxville.)

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