Applied Radiology

Dr. Mirvis is the Editor-in-Chief of this journal and a Professor of Radiology, Diagnostic Imaging Department, University of Maryland Medical Center, Baltimore, MD

I had an interesting experience recently concerning Ellie, our tricolor beagle, now 3 years old. No, my wife Linda and I were not trying to kill her, although it appears that way.

A few weeks ago, Ellie became very listless and stopped eating and drinking. She never stops eating. Linda and I anxiously took her right to the vet. When they got a urine specimen, it was very bloody--that's bad. The vet thought it was a urinary tract infection or bladder stone. They performed a pelvic radiograph ($137) that was interpreted as within normal limits. The vet even showed me the bones on the radiograph. Oh boy!

We took Ellie home with an antibiotic (she had already been on another antibiotic for the prior month for a "possible" UTI, so I was quite doubtful of the diagnosis). The next day she was worse, urinating more blood. I thought she was surely going to die, and I was an emotional basket case. I came home early from work and took her back to another, more experienced vet, in the same office.

This vet was clearly stumped. She said her urine showed no clots, casts, or bugs. Her labs from the prior day were fine. The vet kept her that afternoon and gave her some Ringer's so "she'd feel better." She also thought she looked pale. It's hard to observe this with all that fur, but the sclera and gums are the places to look. They shot another radiograph of her kidneys (another $137 and a normal study). At home that night I gave her another infusion of Ringer's. She looked even worse, she would not even eat chicken: surely a beagle knocking on death's door. I was deep into my old medical texts and the Internet, thinking the dog had acute renal cortical necrosis, rip-roaring glomerulonephritis, perhaps autoimmune disease, or maybe a radiolucent stone. Our Chairman suggested a CAT scan, or DOG scan for the occasion, but I thought that might raise a few eyebrows if word got out.

During the night, she passed blood on the bedroom carpet in five places (that's okay, the carpet was already destroyed from previous beagle assaults) and became unsteady walking. That morning the vet called and told us her hematocrit had dropped from 50 to 29 (in less than 24 hours). She sent us to the Emergency Animal Hospital.

We took her immediately, ignoring every traffic law in the book. It was like a pet Shock-Trauma. They were expecting her, since our vet had called ahead. She was taken directly into the resuscitation area, where 4 people waited to examine and treat her. Her parents were taken to the "quiet room," where they cried their eyes out. After 15 minutes, a young vet came out and told us she had found fluid in the abdomen by sonogram (I'll never put down the use of sonography in the emergency setting again) and she suspected hemoperitoneum (now the doggy abuse suspicions begin, I thought). Anyway, she started taking a full history (labor and delivery, early puppy experiences, first barks, etc.). She finally asked if we had rodent poison out anywhere and then it all magically fell into place. Several weeks earlier, we had put some poison out on our deck-high up, way out of doggy reach-to get whatever creature was making tiny poops around the almost-never-used hot-tub (really important). Recent high winds had blown the box onto the floor of the deck, and Ellie got into it and ate some. We found the opened box that afternoon. We think our Labrador mutt, Cindy, jealously told Ellie to "try it," but Ellie needs no encouragement to eat anything. Anyway, she had been anticoagulated right off the scale; that stuff works. I had learned about the pharmacology of rodent poison in medical school but forgot it in the pressured clinical crunch.

I thanked the vet profusely and am making a contribution to the center. Ellie got put into a cage with blankets and a heating pad (she was pretty chilled by then) and got a unit of FFP and RBCs. We also noticed some bruising on her abdomen and I knew why she had screamed when I picked her up to go to the vet. She had a boat-load of Vitamin K injected and is now getting oral "chewable" (thank goodness) supplemental K for a month. After a few days, she was back to her old obnoxious self, and I am again contemplating her demise-it's a wonderful feeling. Final cost, a little over $2,000 and worth every penny.

Lessons learned:

• The history is the most important part of the examination.
• Don't marry a diagnosis-change your diagnosis when the data doesn't fit.
• Subspecialization is a good thing in medicine.
• A little rodent poop is okay (outside on the deck at least).
• Vets get full payment for radiographs whether indicated or not; reconsider your career choice or that of any offspring contemplating a future in medicine.
• If beagles can find a way to get into trouble, they will (anyone who has one knows this all too well).
• Radiologists are not internists-despite the fact we think we know it all.
• Emergency acute care pet centers are a good idea, just like ones for people.

Excuse me-now I've got to go let Ellie out and in, and out and in, and out and in!