A Dog's Life

"Tell Me About the Patient"

The phone call came at 2:47 a.m., jolting me awake. "Hi. I'm Dr. Sarah Keene, the new surgical resident," I heard a voice say. "I've got a dog here, a ten-year-old spayed female German shepherd. She's bloated and, well ... Sorry. My backup's not answering his pager. Can you come in for the surgery?"

Sitting up in bed and reassuring my wife, Kathy, that the call was for me, I said, "No problem, Dr. Keene. Tell me about the patient."

Bloat -- or GDV, for gastric dilatation and volvulus -- is a true veterinary emergency typically occurring in deep-chested dogs like German shepherds, Great Danes, and standard poodles. Often the animal eats a large meal, gets some exercise, and develops a serious problem about an hour later. The stomach, distended by fermented gas, twists around and flips over on its long axis. The effect is catastrophic. The animal tries to rid itself of food and gas, but nothing budges. The stomach keeps expanding unchecked, squashing the lungs and the blood flowing back to the heart. A dog can die in a matter of hours.

"Is she stable?" I asked.

"Not really," said Dr. Keene. "Her pressures are off the charts, and we're having a hell of a time finding a decent vein, let alone placing a catheter." The dog needed fluids to prevent shock.

My feet were now swinging out of bed as I fumbled for clean clothes. "Do your best to pass a stomach tube. I'll be there as fast as I can."

At this hour of the morning, my eyes were piggy and I had a jaunty case of bed head, but thankfully my patients didn't judge me on my appearance. I drove quickly to the Angell Animal Medical Center in Boston, one of the largest veterinary hospitals in the country, where I'd worked for the past 10 of my 25 years in the field. I saw my patient, Sage, lying across a stainless steel surface in the prep area. Her darting eyes were full of fear; an oxygen mask was on her face. As I approached, her broad and bushy tail offered me a couple of friendly beats.

I liked German shepherds and grew up with one. Yet the wagging tail was utterly surprising and endearing to me given this dog's dire condition. I ran my hand across her soft velvety ear, over the chest and down to the drum-tight abdomen. There was a small shaved square on Sage's flank, where an attempt was made to release the stomach gas with a large-bore needle. The skin was taut; clearly the attempt had failed.

"No luck with a stomach tube?" I asked Dr. Keene after we'd quickly shared hellos and introductions.

"Afraid not. She's in bad shape. Heart rate's 220 with occasional VPCs." She was referring to ventricular premature contractions, or abnormal and ineffective heartbeats.

Sage's tail beat a message of thanks as I relieved her of the oxygen mask and inspected her gums. Instead of healthy, vibrant pink tissue, signifying normal blood flow, I saw an ugly muddy purple. "How much intravenous fluid has she had?"

"This is her fourth liter," said Dr. Keene.

Sage's color looked awful. "She's acting like she's near the end," I said urgently. "Start a lidocaine drip, give her some intravenous antibiotics, and knock her down. The faster we get her stomach untwisted, the better. I'm changing into scrubs."