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
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
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.
- The history is the most important part of the
- Don't marry a diagnosis-change your diagnosis when the data
- Subspecialization is a good thing in medicine.
- A little rodent poop is okay (outside on the deck at
- 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!