king kong on the stomach

after working 13 hours on sunday, i was ready to call it a night. but there were so many patients in the ER waiting room that i decided to take just one last case before calling it a night.

my patient was an 11 month old whippet, according to the card. in the flesh, he looked like a jack russell terrier mixed with something slightly larger but still very terrier-ish. his owner reported that she'd been out of town for 5 days at her father's funeral. she'd left the dog with her boyfriend. on the first day she was gone, the dog had eaten a tube of gorilla glue. FIVE DAYS previously. when the dog (heretofore max) began vomiting shortly thereafter - the boyfriend kicked max outside and left him there for five days. when the owner returned, max was covered in fleas, had not eaten anything in 5 days, and was still vomiting.

i ran preliminary bloodwork to find that max had a PCV of 70! to those not in the vet med world that's really really bad. PCV stands for packed cell volume and represents the percentage of blood that is made up of cells. normal should be between 35-45. 70% meant that this dog's blood was practically syrup. this was confirmed by a visual inspection of the tubes in which we spun the blood - it was chocolate brown and thick. a PCV of 70 represents severe dehydration. i talked to the owner about further diagnostics: bloodwork and xrays. she consented. as i waited for the bloodwork, we placed a catheter and started to slowly administer fluids to correct the severe dehydration. max developed head tremors. i stopped the fluids, the head tremors resolved. i started the fluids again, the head tremors returned. not a good sign by any stretch.

sighing at the impossibility of stabilizing him without causing neurological damage, i consulted my bloodwork. his electrolytes (sodium, potassium, and chloride) were so low as to be at the very end limit of the bottom of our scale. his potassium was 1.9 (life threatening is generally considered to be less than 2). his massive electrolyte imbalances explained the development of head tremors with fluids. then the xrays confirmed my worst fears. the stomach was completely filled with a mass of gorilla glue.

gorilla glue is an interesting substance. it's a poor glue for anything harder than wood. but wood it does well for because it fills in the gaps. it's not an epoxy glue, but a polyurethane adhesive. when it gets wet - it swells to approximately 10-15 times its original size. and that's what happened in max's belly. the good news is that it's not "sticky" per se inside the body. it forms a giant mass, but it doesn't adhere to anything. rather like a big rubber ball. there was a chance that - despite the duration of his illness - max's stomach was still ok. after all - stomachs are made to stretch. i checked his lactate (a measure of blood supply to organs) and it was within the normal limit, which gave me hope that the stomach wasn't dying due to obstruction and stretching.

i discussed all this with the owner - emphasizing first and foremost that stabilizing max would take hours and hours before we could even consider surgery. he was incredibly critical, his electrolytes so out of whack as to be life-threatening. the owner - distraught and confused and quite possibly under the influence of some sort of drug (based on her extremely pinpoint pupils and very erratic behavior, including yelling at the technicians) - elected to go ahead with stabilization and possible surgery, despite the $1600-2500 quote i gave her.

back i went to max, attempting to slowly re-hydrate him, despite the head tremors. and then the owner snapped, insisting on euthanasia. after talking with her some more, she signed the euthanasia form. i walked her to the front desk and returned to do my sad duty to the cute little puppy.

and the woman walked out without paying.

max went to heaven at my hands. after he passed, i opened his abdomen and exteriorized his incredibly massive, hard stomach. the stomach itself still looked viable, still had a good blood supply. i excised into it and removed the 1.5lb mass of rubbery gorilla glue. all in all - a sad end to a day that wound up being slightly in excess of 17 hours.