After Hours Urgent Care has been a long, hectic, challenging, and emotionally and physically exhausting rotation. I've had multiple days when I'm on from 3 pm till 1 or 2 am, then have to come in at 7 am for an hour or two to check on hospitalized patients, then come back at 3 or 4 pm for my next 8-12 hour shift.
But you don't want to listen to me whining, so here are some of the cases I've seen:
1. The young vomiting Labrador from my first night did indeed have a GI foreign body, which was surgically removed at another clinic.
2. Wes, the poodle with huge lymph nodes and circulating lymphoblasts, was definitively diagnosed with leukemia/lymphoma and euthanized when he failed to improve at all after another day in the hospital. Necropsy showed severe diffuse cancer in most of his organs.
3. Kevin, the Pyrenees with an abdominal mass and hindlimb neurologic disease, stayed in the hospital for almost a week, undergoing a splenectomy for a splenic hematoma, and leaving with about the same ability to stand/walk as when he came in.
4. Ethel, a one-year-old rabbit, came in for not wanting to eat that evening. She seemed totally normal on physical exam so we sent her home for syringe-feeding with instructions to return if she wasn't eating on her own in the next 24 hours. She wasn't, so she came back to see the Exotics department, and unfortunately died during a blood draw (she was a lot sicker by that point).
5. Drew, a middle-aged lab mix, was driven to us from several states away for some pretty serious illness. We ended up diagnosing him with huge tumors in his heart, and he was sent to heaven.
6. Wanda, an elderly St Bernard, presented for "bleeding from mouth" -- which she wasn't, by the time she got to us. All we found on a sedated oral exam was a little abrasion at one corner of her excessive lip folds, probably where she just got her huge lips stuck in her mouth while chewing on something.
7. Shaggy, a spastic middle-aged shepherd mix, presented for distended abdomen and nonproductive retching. I happened to be in the lobby with another patient when Shaggy arrived as a walk-in, and you could diagnose a GDV ("bloat") from across the room. Fortunately, her owners had the funds for corrective surgery. Shaggy did well and left the hospital after just a couple days.
8. George, an elderly Lab, presented for seizures. We monitored him overnight then sent him on his way when his owners were uninterested in further diagnostics like MRI. Odds are good that George has brain cancer.
9. Annie, a middle-aged, medium-sized, completely mixed breed dog, presented for anorexia and inability to swallow. We palpated a mass near her larynx, which was confirmed on radiographs. Ultrasound the next day showed that the mass was likely growing off the wall of the esophagus, and we recommended a surgery consultation, +/- feeding tube placement.
10. Pia, an elderly Papillon, presented for seizures. On further discussion with her owner, though, I determined that her "seizures" were actually syncopal episodes (fainting, probably due to heart disease). Radiographs showed Pia to be in heart failure. She was stabilized overnight then transferred to Cardiology.
11. Hershey, a middle-aged lab, presented for drinking and urinating excessively. Based on his physical exam, we strongly suspected hyperadrenocorticism ("Cushing's syndrome"), but bloodwork revealed diabetes mellitus (in addition to probable Cushing's). We sent Hershey home with insulin, and unfortunately his owner won't return any of my follow-up calls to see how he's doing.
12. Violet, a young Shih Tzu, presented for inability to urinate, after she'd been seen several days earlier for the same problem, diagnosed with bladder stones, and had a urinary catheter placed to relieve the obstruction then was sent home. Her owners had finally come up with funds for surgery, and when we couldn't pass a u-cath, the need for surgery became emergent and Violet had a cystotomy at about 2 am.
13. Jimmy, a young-ish Yorkie, presented for vomiting blood, and began having blow-out bloody diarrhea when he got to the hospital. He was transferred to Internal Medicine, diagnosed with hemorrhagic gastroenteritis, and discharged after a couple days of supportive care.
14. Lizzie, a middle-agred Rottie, presented for irritation and drainage from a surgical incision from a tumor removal several days earlier. We diagnosed her with a likely incisional infection, and sent her home with antibiotics and additional pain medications.
15. Gracie, a young cat, presented for vomiting and anorexia of 2 days' duration. Though her belly wasn't painful at presentation, we palpated a probable mass or foreign body in her cranioventral abdomen, and radiographs showed a suspicious gas pattern. Emergency surgery revealed a small intestinal foreign body (a tassel that Gracie had eaten off of a piece of furniture), and Gracie recovered well.
16. Dozer, a young Boxer, presented for swelling on one of his ears, which we diagnosed as an aural hematoma, likely due to Dozer's severe yeast infection in that ear, which was probably due to underlying allergies. Dozer went home with pain meds and ear drops.
17. Willie, an elderly border collie mix, presented for difficulty breathing, with a history of previously controlled diabetes mellitus. We suspected early pneumonia based on lung sounds and radiographs, and Willie was hospitalized on treatment for presumptive pneumonia and started feeling much better within a couple days.
18. Sage, an elderly heeler mix, presented for a suspected gallbladder obstruction based on severe bloodwork changes at her rDVM. We performed an emergency ultrasound, which showed the gallbladder to be pretty normal but the pancreas to be extremely angry. Sage was hospitalized on supportive care for severe pancreatitis.
19. Kodiak, an older Lab, presented for possible stick in his esophagus, after the owners saw him trip and hit the ground while carrying a stick in his mouth. Radiographs didn't reveal much of anything (as we suspected they might not), so Kodiak went home with antacids and pain meds for presumed esophagitis.
20. Taco, a young Chihuahua, presented for possible allergic reaction to a bee sting. However, on presentation Taco was only somewhat responsive and very ataxic, had a low heart rate, was hyper-reactive to loud stimuli, and was dribbling urine -- all classic signs of marijuana toxicity. Taco was hospitalized on IV fluids and activated charcoal to help the pot get out of his system, while we all laughed hysterically at his stoned antics.
